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Psychiatry Clerkship > Diagnosis and Treatment > Flashcards

Diagnosis and Treatment Flashcards

1
Q

Scizophrenia

A

Must be symptoms for 6 months
Can have had negative symptoms for years and just recently developed positive symptoms. This would still count as 2 years.
Treatment is antipsychotics

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2
Q

Schizoaffective

A

Must have a baseline mood disorder, often lasting years. Then have psychotic episode lasting at least 2 weeks that occurs in the absence of mood symptoms.
Treat with SSRI and antipsychotic

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3
Q

Depression with psychotic features

A

Psychotic features will only occur when there is a depressive episode
Treat with SSRI and antipsychotic

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4
Q

Schizophrenia Neurobiology

A
  • Increase in dopamine in mesolimbic system, responsible for positive symptoms
  • Decrease in DA in prefrontal and cortical systems, accounts for negative symptoms
  • Treatment is antipsychotics that block D2 receptors and lead to improvment of positive symptoms. Atypicals have more effect on seretonin and Ach and can effect negative symptoms as well.
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5
Q

Dystonia

A
  • Occurs acutely after the start of antipsychotic treatment (12 hrs), stuck in one position.
  • Treat with Ach antagonists (Benztropine, Benadryl)
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6
Q

Akathesia

A
  • Feeling of restless legs, wanting to move but can’t
  • Generally occurs less than 3 months after the start of teratment
  • Treat with beta blocker first line (propranolol), Benzo is second line
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7
Q

Parkinsoninsm

A
  • Parkinson like symptoms
  • Occurs greater than 6 months after starting neuroleptics
  • Do not treat with levo-dopa
  • Treat with Benztropine/diphenhydramine, amantadine/bromocriptine
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8
Q

NMS

A
  • Rigidity, elevated CK, hyperthermia
  • 1st stop drug and provide supportive care/cooling
  • 2nd dantrolene (can also use benztropine, but dantrolene is preferred)
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9
Q

Panic Disorder

A
  • Episodes of panic attacks and the intervening intervals are characterized by worry about a future attack
  • Benzos for short term in acute setting only, do not give long term because of withdrawl and dependence
  • SSRI used for longterm managment
  • Avoid benzos in COPD, Restrictive lung disease, addicts
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10
Q

Benzo Withdrawl

A
  • Mimics DT
  • Treat with librium and ativan
  • haldol if psychotic
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11
Q

Specific Phobia

A
  • Treat with flooding and desensitization

- Can give benzo in acute setting

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12
Q

Performance Anxiety Only

A

Propranalol is first line

-Benzos are second line

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13
Q

Social Anxiety

A
  • SSRI, SNRI are first line

- Benzos can be used acute, but are not considered mainstays of therapy

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14
Q

Avoidant Personality

A
  • Hypersensitive of rejection

- Has few close friends

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15
Q

GAD

A
  • Must have symptoms for 6 months
  • Restless, fatigue, decreased concentration, sleep, muscle tension
  • Often comorbid with other psych disease
  • CBT/relaxtion + SSRI is first line
  • Can use benzo in acute settings, but not for longterm managment
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16
Q

OCD

A
  • Often seen combined with tourettes
  • Distinguish between OCD and OCPD
  • Tx: SSRI, exposure response therapy
  • Can use clomipramine of the TCA’s available
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17
Q

PTSD

A
  • Must have symptoms for longer than 1 month
  • syptoms must be related to life threatening event, otherwise it is an adjustment disoreder
  • SSRI (Sertraline, paroxatine) are mainstay of treatment
  • Prazosin can be used for nightmares
  • Can use CBT
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18
Q

Acute Stress Reaction

A
  • Lasts less than 1 month.
  • Exposur and response therapy may reduce PTSD
  • Benzos can be used in acute setting
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19
Q

Adjustment

A
  • Must occur within 3 months of event and last less than 6 months after it leaves
  • Can mimic PTSD, but is not from a life threatening event
  • Supportive psychotherapy is the mainstay of treatment
  • Can also give symptomatic managment (z drugs for sleep, benzos for anxiety)
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20
Q

Munchausen

A

-Actually undergo painful, or unnecessary procedures

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21
Q

Facticious

A

-Say you are sick, but are actually not

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22
Q

Malingering

A

-Saying you are sick or injured for secondary personal gain

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23
Q

Bulemia

A
  • Binge and excess response, normally have normal weight, difference between anorexia
  • If vomitting can present with a hypochloremic metabolic alkalosis, elevated amylase
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24
Q

Anorexia

A

-Most common cause of death is heart disease
Second is suicide
-Treatment is primariliy based on nutritional rehab and CBT
-Can us SSRI as well

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25
Q

Refeeding syndrome

A
  • Fluid retention
  • Decreased phosphate, mag, Ca
  • Can be deadly
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26
Q

Sleep

A
  • Slow wave is restful and is when sleep talking/walking/terrors occurs
  • REM is when nightmares occur, total paralysis
  • REM increased and decreased REM latency in depression
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27
Q

Insomnia

A
  • First step is sleep hygeine

- Next can try Z drugs, benzos

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28
Q

Restless leg syndorm

A
  • Caused by Fe deficency anemia, renal disease, or neurtopathy
  • First correct underlying problem
  • Then can treat with Da agonists (ropinorole, pramipexole)
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29
Q

OSA

A
  • Keep in differential for sleeping issues

- Treat with CPAP

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30
Q

Narcolepsy

A
  • Uncontrolled attacks of REM sleep often related to emotions
  • Has hallucinations and loss of muscle tone
  • Treat with scheduled modafanil
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31
Q

Schizoid vs Avoidant

A

Schizoid don’t want friends. Avoidant want friends but don’t have them

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32
Q

Schizotypal

A
  • Have odd magical beliefs
  • Often can appear schizophrenic because are disheveled and have strange ideas
  • Lack true delusions and lack hallucinations
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33
Q

Antisocial

A
  • OFten comes to kids with ODD, ADHD

- Often are associated with substance abuse issues

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34
Q

Borderline

A
  • Splitting is common feature

- Unstable relationships and cutting

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35
Q

Histrionic

A
  • Provacative
  • Often hypersexual and have eating disorders
  • Distinguish from borderline by lack of splitting, cutting, and UNSTABLE relationships
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36
Q

Dependent

A

-Often have comorbid depression or anxiety

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37
Q

Delerium

A
  • Biggest risk factors are age and dementia
  • Look for medications causing (Benzos, opiates, anticholinergics)
  • Look for infection
  • Treatment is to remove/fix underlying cause
  • Reorientation and haldol if agitated
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38
Q

Alzhiemer’s Dementia

A
  • AB plauqes, tau tangles
  • APP chromosome 21
  • APO E
  • Tx: ACHesterase inhibitors (donepazil, rivastigmine, galanimantine)
  • Memantine glutamate NMDA receptor antagonists
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39
Q

Frontotemporal dementia

A

-Hypersexual, disinhibitied, apathetic
-Can treat with olanzapine
INtracytoplasmic silver staining

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40
Q

Lewy Body Dementia

A
  • Alpha synuclein inclusions
  • Hallucinations, shuffling gate
  • Tx is Achesterase inhibitors, don’t give L-DOPA or neuroleptics
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41
Q

Vascular Dementia

A

-Older, stepwise

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42
Q

Crutzfeld Jakobs

A
  • Myoclonus

- EEG will show triphasic bursts, sharp waves

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43
Q

Tertiery Syphilis

A
  • Look for loss of sensation, argyll robertson pupil
  • IV looking for bacteria
  • Tx is IV penacilin
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44
Q

NPH

A
  • Wacky Wobbly and Wet

- Treatment is VP shunt

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45
Q

Personality Disoreders

A

A: Wacky (schizoid, schizotypal, paranoid)
B: Wild (Borderline, Histrionic, Narcassistic, antisocial)
C: Worried (Avoidant, OCPD, Dependent)

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46
Q

Personality Associations

A

Borderline: DBT (Dialectic behavioral therapy), also commonly see splitting, and suicide is major cause of death. Borrderlines are more treatable than others though.
Antisocial: Must develop from conduct order below age 15, commonly see substance abuse
Avoidant: Commonly have social phobia which can be treated and can help in symptom managment
Dependent: Can display imature coping mechanism of regression

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47
Q

Abuse

A

Must have one criteria for the last 12 months

  1. Legal trouble related to the addiction
  2. Not fulfilling personal responsibilities
  3. Dangerous use
  4. Continue use in presence of danger and legal trouble
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48
Q

Dependence

A

Have for 12 months, 3 symptoms

  1. Tolerance
  2. Withdrawl
  3. Loss of interest in previous enjoyed activities
  4. Excessive effort to obtain drug
  5. Want to stop but unable to
  6. Continue use with problems
  7. Use more than intended
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49
Q

Alcohol Addictoin

A
  • Converted to aldehyde in liver and converted to acid

- GABA agonist

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50
Q

Alcohol withdrawl

A
  • Immediately will show autonomic hyperactivity
  • Later will show DT (48-72 hrs)
  • Treatment is long half life benzos (librium and diazapam)
  • Depression cannot be diagnosed while patient is under the influence of alcohol. Is called alcohol dependednt depresive disorder
  • Worse if patient is hypomag
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51
Q

Alchol Dependence Treatment

A
  • Antabuse blocks aldehyde hydrogenase, leads to icnrease in aldehyde and leads to unpleasant feelings. Not in cardiac disease, pregnancy, psychosis
  • Alcamprosate: Weak gaba agonist and can block glutamate, used to decrease cravings. Best used post detox to prevent relapses.
  • Naltrexone: Opiate blocker used to inhibit cravings
  • Topirimate: Gaba agonist and decreases cravings.
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52
Q

Alcohol problesm

A
  • Wernicke encephalopathy: Opthalmoplegia, ataxia, confusoin
  • Korsakoffs: Confabulation and anterograde amnesia worse
  • Both are caused by decrease B1
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53
Q

Cocaine

A
  • Blocks DA reuptake
  • Causes vasocrontriction and can lead to MI/arrythmia/siezures
  • Do not give beta blockers because it might potentiate a MI
  • Treat symptoms: Benzos and haldol for agitated delerium
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54
Q

Amphetamines

A
  • Cause release and impaired reuptake of DA, NE, 5HT
  • May precipitate seretonin syndrome when patietn is on SSRI
  • Ecstacy is under this class and is classic for causing seretonin syndrome
  • Can also cause renal failure: Dehydration and rhabdo lead to AKI
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55
Q

Ecstacy

A
  • Considered under amphetamine
  • Can precipitate seretonin syndrome
  • LEads to excessive thirst
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56
Q

PCP

A
  • Nystagmus, Siezures, Hallucinations, HTN
  • Blocks NMDA receptor and is DA agonist
  • Treat with benzos and haldol for sedation and agitated psychoisis
  • Can cause rhabdo because of extreme tension in muscles
  • Lipophilic and can have flashbacks when release from fat stores
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57
Q

Sedative Hyptonitcs

A
  • Benzos cause increased frequency of Cl channel opening
  • Barbs cause increased duration of Cl channel opening
  • Barbs can kill, generally benzos don’t alone
  • Alcohol potentiates and can kill with both
  • Withdrawl symptoms are similiar to alcohol withdrawl
  • Flumezanil is used for benzo overdose
  • Supportive therapy and alkalinization of the urine is used in barb overdose
  • Can use a benzo taper (librium) or carbamezapine/valproated for withdrawl/dependence
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58
Q

Opiods

A
  • May cause seretonin syndrome
  • Classical prsentation
  • Meperidine or demerol causes mydriasis, doesn’t cause miosis. ONly one.
  • Tx of OD is supportive and naloxone
  • Treatment of dependence/withdrawl is
  • Clonodine, NSAIDs, Dicyclomine for mild withdrawl
  • Buprenorphine and methadone for longer withdrawl
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59
Q

Hallucinagens

A

-LSD,
-PResentation can mimic stimulants
-No real physical dependence
-Can have flashbacks to hights
Treatment is supportive for agitated pschoise give benzos and haldol

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60
Q

Marijuanna

A
  • Inhibits adenylate cyclase

- Can have acute agitation and cna occur on withdrawl

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61
Q

Inhalants

A
  • Can have sedative or stimulant properties, but generally sedative
  • Acute OD is generally supportive
  • Can cause longterm damage to brain leading to retardation and lower IQ
  • Can lead to nystagmus and psychoises
  • Treat with benzos and haldol for agitated delerium
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62
Q

Caffeine

A
  • Adenosine antagonist leads to increase in cAMP
  • Leads to increase DA
  • Stimulant
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63
Q

Nicotine

A
  • Nicotinic agonist and increase DA
  • Treatment for addiction is nACHr partial agonist
  • Varencycline
  • Buproprion: Also inhibits DA uptake
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64
Q

Schizophreniform

A

-Symptoms that are part of schizoid personality disorder do not count towards time of 6 months.

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65
Q

Concrete thinking

A

Unable to abstract. Can’t understand or explain metaphors

-Seen in children, people with cognitive defects, and schizophrenics

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66
Q

Diagnosis of suspected MR

A

IQ test

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67
Q

Depression in Kids

A
  • Often presents with acting out or with irritability

- Becks can be given to diagnose in kids older than 13

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68
Q

Predictors of Violence

A
  • Male, age 19-24, alcohol, low SES, acute stress

- History

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69
Q

Care of a violent patient

A
  • If patient is observed to be violent patient must be put in restraints first
  • Then he can be given IM haldol and lorazapam
  • Then he can be reasoned with
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70
Q

Countertransference

A
  • When the physician responds to the transference of the patient.
  • Basically the way that a psychiatrist feels/acts with a patient in a broad sense
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71
Q

HIV Dementia

A
  • Look for in younger patients presenting with dementia

- Seen more ommonly in patient with a CD 4 less than 200

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72
Q

Blocking

A

-Patient will stop in mid sentence and not be able to finish

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73
Q

Derealization vs Depersonalizatoin

A
  • It is all in how the patient says and how the vignette words it
  • Derealization is a patient feeling out of touch with the world and like the world isn’t real
  • Depersonalization is thinking that the patient isn’t real
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74
Q

Magical thinking

A
  • Thoughts have powers. Thinking that because the patient thought something that something else happened
  • Patient thinks there might be an earthquake and then there is one, patient thinks thoughts have powers
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75
Q

Nihilism

A

-Thought that the world is not real or the pateitn or people are dead/not real

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76
Q

Echolalia and Echopraxia

A

-Echolalia is spoken. Echopraxia is motions

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77
Q

Malignant Hyperthermia

A

-Increase Temp, acidosis, familial

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78
Q

NMS

A

Rigidity, recent started drugs, rigidity, altered conciousness. Not necessarily familial

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79
Q

Thyrotoxicosis

A
  • Look for in post stressed patient (Pneumonia etc)

- Hyperthermia, dysutonomia, emergent, etc

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80
Q

Seretonin Syndrome

A
  • Hyperreflexia
  • Shivering, diahrrea,
  • Occurs when taking SSRI, MAOI, L-Tryptophan, ondansetron, opiods, etc
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81
Q

Hepatic encephalopathy EEG

A

-Triphasic bursts

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82
Q

Toxic Encephalopathy/delerium

A

-Background slowing

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83
Q

Stroke

A

-Laterializing periodic

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84
Q

Ericsonian 0-1

A

Trust vs mistrust

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85
Q

ERicosinian 1-3

A

Autonomy/confidence vs Shame/dount

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86
Q

Eric 3-5

A

Initiative vs guilt

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87
Q

Eric 21-40

A

Intamacy vs isolation

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88
Q

Eric 40-65

A

Generativity vs stagnation

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89
Q

Eric 65+

A

Integrity vs dispair

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90
Q

Eric 6-11

A

Industry vs Inferiority

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91
Q

Eric 12-20

A

-Identity vs confusion

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92
Q

Tardive

A
  • Can switch to clozapine which has less likilhood

- Can also use clonidine or tetrabenzaine

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93
Q

SSRI Birth Defects

A
  • Can cause withdrawl symptoms in the newborn

- Persistent Pulmonary HTN of the newborn is the most feared complication

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94
Q

SSRI discontinuation syndrome

A
  • Paroxatine (Paxil) is most likely to cause

- Fluoxetine is least likely

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95
Q

Interferes with lamotragine metabolism

A

-Oral contraceptives can decrease levels of lamotragine by effecting liver

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96
Q

Trazadone mechanism of action

A
  • Blocks alpha, histamine, seretonin

- Major indication is insomnia but also functions as an antidepressant

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97
Q

Lithium Cardiac effects

A
  • Causes inverted or malformed T waves

- Do not prescribe in any conduction defects

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98
Q

Lithium Renal Clearance Interference

A
  • NSAIDs are the most common
  • Diuretics are also common (HCTZ, K sparing)
  • Also metronidazole and tetracyclines
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99
Q

TCA for OCD

A

-Clomipramine

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100
Q

Refractory OCD med

A

-Atypical antipsychotic added to SSRI or clomipramine

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101
Q

Orthostatic hypotension

A
  • TCA, especially imipramine (Used for bedwetting)

- Also antipsuychotics, except haldol

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102
Q

Combative Patients

A
  • Always sedate first

- If combative and delerious give haldol

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103
Q

Undoing

A

-The compulsive act that occurs as a result of intrusive fantaical thought

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104
Q

Child phases of detachment

A
  • Protest
  • Despair
  • Permanent Detachment
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105
Q

Ideational Apraxia

A

Unable to do complex stepwise activities

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106
Q

Cataplesy

A

-The ability to maintain postures for long periods of time

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107
Q

Temporal Lobe Epilepsy

A

Intense emotions, perseveration in interactions, hyposexuality
-WIll also show abnormal EEG

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108
Q

Migraine Headache

A

5-HT1D

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109
Q

Depression

A

5-HT1A

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110
Q

Psychoisis

A

D2, site of 1st generation antipsychotics

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111
Q

Atypical antipsychotics

A

D4 and 5-HT6

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112
Q

Damage to prefrontal Cortex

A

Can change mood and affect. Right damage leads to happiness and left damage leads to sadness

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113
Q

Vitamin E excess

A

Causes disruptions in clotting and can lead to hemorrhage and stroke

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114
Q

2 Separate Neurologic Findings

A

Think MS first

115
Q

ADHD Diagnostic Criteria

A
  • Symptoms must have been present before age 12
  • Symptoms present in 2 locations
  • Symptoms present for more than 6 months.
116
Q

Night Terror

A
  • Occurs during stage 3 non rem sleep
  • Patient has no recollection
  • Patient should not be awakened and treatment should occur by making the surrounding area safe
  • If refractory, benzos have been shown to be effective in some cases
117
Q

Childhood Depression

A
  • Irritability is a more common presenting symptom

- More commonly associated with hallucinations or evidence of psychosis (1/3 of patients)

118
Q

Alzhiemers is not frontal lobe dementia

A

-Will not show classic signs of loss of inhibition

119
Q

Subdural hematoma

A

-Can cause a transient dementia like state in younger patients.

120
Q

Generalized Siezure

A
  • Hard to tell from partial complex

- If there are multiple motor or psychologic systems and there is loss of conciousness it is most likely generalized

121
Q

Neuroleptics in delerium

A
  • In delerium there is an increase in DA and a decrease in Ach.
  • Haldol is best drug because it has no anticholinergic activity and will thus keep Ach high
122
Q

Panic Disorder

A
  • Occurs spontaneously

- If it is provoked in a certain setting then it is likely a specific phobia (unless it is part of agoraphobia)

123
Q

HIV Dementia

A
  • Always keep in mind in younger patients

- Will show volume loss and imaging changes on MRI

124
Q

Wernicke Encephalitis

A
  • Treat with Thiamine and can resolve

- There is 6th nerve hyperactivit

125
Q

Korsakoff Amnesia

A
  • Is retrograde and anterograde

- Often it is the anterograde that causes the confabulations

126
Q

DT vs Delerium

A

-In DT there is likely more physiologic findings. There will also be no alternating with somnolence as is seen in delerium

127
Q

Siezure Hormone

A

-Prolactin is increased in Siezures

128
Q

Steroids

A
  • Can cause all kinds of psych symptoms

- Mood disorders including bipolar and depression are the most common

129
Q

Brief Psychotic Episode

A
  • Must occur for less than one month and more than one dy
  • Often occurs following emotional trauma
  • Must have evidence of psychosis
  • Must resolve on it’s own
130
Q

Drug causes of psychosis

A

-Cocaine, PCP, LSD

131
Q

Signs of psychosis vs malingering

A

-Psychosis is most often auditory hallucinations. Visual hallucinations are more likely caused by medical condition (Alcohol) or malingering

132
Q

Hyponatremia

A
  • Common in lithium and carbamezapine
  • Also can occur in schizophrenia/psychosis due to psychogenic polydypsia
  • Look for signs such as siezure, confusion, and thirst
133
Q

Treatment of single psychotic epiosde

A
  • If treatment is undertaken such as in schizo

- If patient is symptom free for 3 years then can discuss the reduction in treatment

134
Q

Terminal patients

A
  • Delusions are most common (90%)

- Depression and anxiety also occur at a large rate

135
Q

Autoscopic hallucinations

A

-A ghost is following me

136
Q

Capgrass

A

-Everyone has been replaced by their identical double

137
Q

LYcanthropy

A

-Thought that you are turining into an animal (Werewolf

138
Q

Cotard

A
  • Everything about you is dead and lost

- Lost money, house etc, even lost internal organs

139
Q

Koro

A

Korean Shrinking penis

140
Q

Amok

A

Malay violence

141
Q

Dhat

A

Indian sexual dysfunction

142
Q

Rest of cultureal

A

Psychosis

143
Q

Dysthymia treatment

A
  • Venlafaxine, buproprion first line

- MAOI is second line

144
Q

Effects of sleep on mood

A
  • Anti-depressant

- Mania inducer

145
Q

Post Partum

A
  • No longer diagnosis, must meet MDD criteria and is considered peri-partum subtype
  • 2 weeks, anehodina is often distinguishing feature.
  • Insominia is not a factor
  • Psychosis: If hear baby crying when it is not.
146
Q

SAD

A
  • Criteria is not enough for MDD

- Hyperphagia and hypersomnia are most common symptoms

147
Q

Bipolar with depression

A
  • Treat with lithium and SSRI for depressed episode

- Taper off SSRI ASAP to prevent provoking mania

148
Q

Disruptive Mood Dyregulation

A
  • Irritability is the prominent feature
  • Very common in kids
  • Often is longer term in adults
  • Doesn’t meet criteria for MDD
149
Q

When to treate Mood 2 to general medical condition

A
  • If mood disorder is present for more than 6 weeks post resolution of medical condition then you should treat the mood disorder.
  • Treat depression 6 weeks after correcting thyroid levels
150
Q

ECT

A
  • Memory issues get all the credit
  • HA, nausea are more common
  • Contra is space occupying lesion or MI within 6 months
151
Q

Augmentation of SSRI

A
  • Never use 2, or combine with MAOI or TCA b/c of seretonin syndrome
  • Lithium is first line
  • Can also use stimulants, Thyroid, hormones, light
152
Q

GAD treatement

A

SSRI and busprion are both first line. If there are contrainditation to SSRI use busprione

153
Q

Initial TX of panic disorder

A

-Use benzo with SSRI, taper benzo as SSRI effects come online (6 weeks)

154
Q

Erection SE

A

-Of SSRI, fluoxetine is least likely, but bupurprion is still the best choice

155
Q

Perphenazine

A

Can cause issues with ejaculation, not erection

-Maybe similiar among other neuroleptics

156
Q

Differentiate between OCPD and Narcisism

A
  • Perfectionist and orderely freak is OCPD
  • Narcisist will have anger with things other than orderliness
  • Narrow in many presentations
157
Q

Tx of Narcisism

A

-Difficult

Psychodynamic will be most effective although all are not great

158
Q

Primary Hypersomnia

A

Consider when all disorders of sleep have been ruled out in a patient with excessive daytime sleepiness

159
Q

OCD vs OCPD

A

Be careful to determine degree of ego-syntonicism

160
Q

Location of brain with mood disorders

A

Frontal lobe will show changes on fMRI

161
Q

Li EKG

A

Flattenting of T waves and inverted U waves

162
Q

Contraindications for Li

A

MI, MG, Renal disease, Diuretics, NSAIDs

163
Q

Tx of Mania in first trimester of pregnancy

A

Clonazapam

164
Q

Hepatitis in treated maniac

A

Valproate

165
Q

SJ in maniac

A

Lamotrigine

166
Q

Aplastic Anemia in Maniac

A

Carbemazapine

  • Monitor weekly when WBC less than 2k
  • DC when WBC less than 1 k
167
Q

Depression first question

A
  • SI

- Never forget to ensure patients safety before treating

168
Q

Sleep in depression

A

Decreased REM latency and overall increase in REM

169
Q

Patients where venlafaxine should be careful

A

-Hypertensives

170
Q

Treatment of tyramine/MAOI induced hypertensive crisis

A
  • Phentolamine

- Alpha blocker

171
Q

TCA EKG findings

A
  • Causes heart block””
  • Lengthens QT and PR, causes torsades
  • Tx is activated charcoal within 2 hours otherwise is Na bicarb to stabalize cardiomyocyte membrane
172
Q

Schizophrenia Neurobiology

A
  • Increase in DA in limbic circuits

- Decrease in DA in meso-cortical, prefrontal (negative symptoms). Atypicals can make this worse

173
Q

Schizoaffective disoreder

A

-Treat both psychosis (with neuroleptics) and depression (with SSRI)

174
Q

Chlorpromazine

A

-Metalic rash in sun exposed areas

175
Q

Thioridizine

A

-Pigmented retionpathy and increasd QT

176
Q

Parkinsons

A

-Treat with anticholinergic, or bromocriptine. Do not give L-DOPA

177
Q

Arirprazole

A

-Weight neutral, but causes akathesi

178
Q

Quetipine

A

-Long QT, Orthostatics, cataracts

179
Q

Benzos relative contraindications

A

-Restrictive Lung disease, COPD

180
Q

OCD Treatment

A

Chlomipramine is approved SSRY

Otherwise use SSRI

181
Q

Anorexia

A
  • Must decifer using BMI
  • Treatment is aggressive nutritional therapy and counseling
  • Bulemia is SSRI
182
Q

Refeeding Syndrome

A

-Low Phosphage, Mg, Ca, fluid retention

183
Q

Anorexia Diagnosis

A
  • Everything is low. Leukopenia, Bradycarida, hypothermia
  • Amylase high
  • K, Cl low. Bicarb high
  • Hypercholesterolemia
  • Increased carotene and LFT
184
Q

RLS

A
  • Look for Fe deficency anemia or renal disease

- Treatment is ropinorole or pramipexole

185
Q

Paranoid PD

A
  • Look for multiple paranoia over many boundaries
  • Doesn’t hace negative symptoms of shizophrnia
  • Remembrer schizophrenia needs at least 2 of 5
  • Can treat with anutipsyhotics is delusions are interferring with life
186
Q

Condunct

A

-Must diagnose in the history of ADHD

187
Q

Alzhiemers Tx

A
  • AcheI: Donepazil, galantamine, rivastigmine

- Memantine is Glutamate antagonist

188
Q

Frontotemproal

A
  • Silver stained intranuclear inculsions
  • Sexually explcicit
  • Can give olanzapine to depcrease sexual comments
189
Q

Lew Body

A
  • Hallucination
  • Parkinson features
  • Can treat with AchE inhibitors
  • Do not give L-DOPA or neuroleptics
190
Q

Alcohol Withdrawl

A
  • First Symptoms are 12-24 houts
  • Hallucinations and full DT are 48-72 hours
  • Treatment of choice is diazepam and chlordiazepoxideb because of long half life
  • If liver failure choose lorazapam, oxazapam, or terazapam
  • If pt is on beta blocker testing hyperreflexia is a good indicator when autonomic signs are masked
191
Q

Etoh specific test

A
  • Carbohydrate deficent transferrin is most specific

- GGT is also goof

192
Q

Amphetamine Treatment

A

Treat cardiovascular effects with Ca channel blocker no beta blocker

193
Q

Diagnosis of ADHD

A

-Requires 2 settings. Symptoms only reported by parents are not enought

194
Q

Methylphenadate

A

-DA reuptake inhibitor

195
Q

Amphetamine

A

-DA, NE reuptake inhibitor and causes release

196
Q

Atomoxatine

A
  • NE reputake inhibitor

- Not an amphetamine

197
Q

ADHD others

A

-Can also give clonidine or guanfacin

198
Q

Tourettes

A
  • mUst have tics for 1 year with less than 3 montht tic free
  • Highly associated with OCD
  • Treat with clonidine, or haldodl if clonidine doesnt work
199
Q

Rumination disorder

A

Check lead levels

200
Q

Alcohol withdrawl hallucinations

A

-Treatment with benzos will treat both. Only give haldol if patient is a agitated

201
Q

Terminal illness depression

A

-Often, if patietns are terminally ill a stimulant can be used as its antidepressant effects take less time to occur when compared to SSRI

202
Q

Huffing symptoms

A
  • HA, depressed reflexes

- Treatment is absitence

203
Q

Mood stabilizer that causes hairloss

A

-Depakote. Divalproex

204
Q

Treatment resistant ADHD

A

-If one class of stimulant doesn’t work then try the other

205
Q

Treatment during pregnancy

A
  • Psychosis: Haldol

- Mania: Benzos (Ch)

206
Q

Somatoform disorders

A
  • Somatization
  • Pain
  • BDD
  • Conversion
  • Hypocondriasis
  • Facticious
  • Malingering
207
Q

Somatization

A
  • Complaints regarding multiple body systems. 4
  • 2 GI complaints
  • One Reproductive complaint
  • May be real, but in excess of warranted
  • Tx: Meet regularly with PCP, don’t broach mental illness initially
  • Often comrrbid with depression and anxiety. Look for history of abuse
208
Q

Pain Disorder

A
  • Pain is the predominant symptom
  • Analgesics don’t help
  • Can be exacerbated by depression
  • Tx: SSRI, Biofeedback
209
Q

Conversion

A
  • Neurologic symptom
  • Often preceded by psychological stressor
  • Tx: Insight directed psychotherapy
210
Q

Hypochondriasis

A
  • Patient is worried about contracting serious illness.
  • Emphisis on worry and contracting SERIOUS illness
  • Different from somatization in that complaints aren’t always symtpoms, but complaints are fear of contracting seruous illness
  • Highly comorbid with anxiety and depression
  • Often best treatment is to treat other mental illness. See PCP regularly, don’t do invasive testing
211
Q

Factitous

A

-Concisouly producing symptoms for primary gain

212
Q

Malingering

A

-Conciously producing symptoms for secondary gain.

213
Q

Dissociative amnesia

A
  • Know that they forgot memory
  • Often seen surrounding trauma or stress
  • Not associated with travel or leaving area
  • Abreaction: when there is anxiety over retrieval of traumatic memories
214
Q

Fugue

A
  • There is always travel involved
  • Patient is unaware that there is some memory missing
  • Little anxiety
  • Often comprbid with serious mental illness or brain injury
215
Q

Depersonalization

A

-Feeling detached from person

216
Q

Ganser

A

-Approximate answers

217
Q

Ataque de Nervios

A

-Hispanic trance culturally bound syndrome

218
Q

Impulse Control Disorders

A
  • Occur due to internal compulsion, anxiety over doing something
  • The compulsion occurs and the patient feels better
  • The patient often feels remorseful about the consequences
219
Q

Intermitent explosive

A
  • Anger outbursts with remores

- Treatment is SSRI, propranolol, Li

220
Q

Kleptomania

A

-Highly correlates to OCD and eating disorders
-Highly remorseful
Tx with SSRI, exposure therapy

221
Q

Pyromania

A
  • Distinguish from conduct because these patients have an intetst in setting fires
  • Eerything is fixated on fires
  • Compulsion with relief
  • Tx: Psychotherapy and watching patients
222
Q

Anorexia

A
  • Associated findings: Increased BUN, Incresed Cortisol, hypernatremia
  • QTc prolongation, ST-T changes,
  • Death by arrythmia or suicide
  • Refeeding: Hypo P, Ca, Mg. Fluid retention, arrythmia, delerium
  • MDD can present with weight loss, distinction is MDD there is loss of appetite while in anorexia appetite is still there
  • Tx hospitilization, CBT. Can use atypicals, and benzos as adjunctive treatment
223
Q

Bulemia

A
  • Highly associated with OCD
  • Ego dystonic and causes distress
  • SSRI is mainstain of treatment, fluoxetine
  • B and C personality
  • 2x/wk for 3 months
224
Q

Binge Eating

A

No concern with body weight
-Treatment is CBT and weight loss often times
2x/wk for 6 months

225
Q

Dysomnias

A
  • Difficulty falling asleep
  • Treatment begins non pharmacologically with sleep hygeine and CBT
  • If those fail then can use Benzo, trazadone, z drugs
  • All are characterized by increased daytime sleepiness
226
Q

OSA

A

-CPAP

227
Q

Narcolepsy

A
  • Catalplexy, etc
  • Treatment is modafanil or stimulants
  • Also frequent naps
228
Q

Circadian rythm disorders

A
  • Circadian rythm is set by Supra Chiasmatic nucleus in hypothalamus
  • REM sleep has increase arrousal
  • Treatment is generally behavioral
  • Can give modafanil to shift work and jet lag
229
Q

Primary hypersomnia

A

-Rare

230
Q

Klein Levin

A

-Primary hypersomina with hyperphagia

231
Q

Parasominas

A
  • Unusual behaviors
  • Best treatment is to keep area safe
  • Can use benzos in refractorty cases
232
Q

Types

A

Sleep terror
REM sleep (Walking, kicking etc)
Nightmare (Can us IRT)
Risk is increasd in all with age and psychotropic medication

233
Q

Sexual Psych

A
  • DA increase libido, 5HT decreases
  • Narcotics inhibit desire. Cocaine, Alcohol, Canabis increase
  • Alcohol and canabis often cause impotence howerver
  • Consider drugs, physical, psychological factors in determining etiology of sexual disorders
  • Hypoactive desire (pts don’t have desire). Sexual aversion is patients actively against.
  • Vaginismus is muscle contraction, dyspareunia is pain
  • paraphilias are 6 months
  • Gender ID is generally established by 3 years
  • Some currioisity about homosexuality is normal and should not indicate future homo activities
  • If there is distress regarding homo then it is likely MDD, not sexual disorder
234
Q

MR Causes

A

-Anoxia, downs, Fragile X, Kernicterus,TORCHES

235
Q

Learning Disability

A
  • Problems with learning and school functioning even though normal IQ, Education, Development
  • Always check sensory defecits
236
Q

ODD

A

-Must be present for 6 months
-There will be defiance to people in authority while often interacting appropriately with peers
-There will be no major violation of rules or rights
-Seen commonly in ADHD
TX: trreat underlying ADHD, also can use psychotherapy

237
Q

Conduct

A
  • In childern less than 18
  • There is obviousl violation of rules and rights
  • There is no fascination with activity, just don’t care
  • highlt comorbid with ADHD, learning disorders and abuse Hx
  • Tx: difficult, treat underlying disorder if it exists, can estabilsh firm rules
238
Q

ADHD

A
  • Must be diagnoised with input from 2 scenarios

- Can be caused by Pb poisoning or from smoking during pregnancy

239
Q

PDD

A
  • Autism specturm
  • Impaired communication, language, and procupation with certain things
  • Make sure to check hearing and sensory functions
240
Q

Rett

A
  • Develop until 5 monhts. Have small head, writhing movements, Lowered siezure threshold
  • Disintirative disoredr. Develop until 2 years and then lose functions til generally 10 years of age. There will be no small head or stereotyped movements.
241
Q

Tourettes

A
  • Tics for 1 year with less than 3 months absedn
  • Can be supressed
  • Comorbid with OCD, ADHD
  • Treat with clonidine 1st lnie. Can use atypicals as second line. Can use typicals in refractory
  • Be careful with using stimulants to treat ADHD in the context of touretts as it often makes things worse
  • Can give SSRI in OCD pts
  • Symptoms generally worse during early puberty and improve a patient grows
242
Q

Elimination

A

It is normal to not be potty trained through 4 years. If elimaination disorderes exist they are diagnosed after 5 years of age
-Often spontaneously remits by 7 years

243
Q

Selective Mutism

A
  • There will be a single ocation where the child will refuse to talk
  • Will be normal in other areas
  • Be sure to eliminate learning disorder
  • Girls>boys
  • Tx is behavioral therapy
244
Q

Separation Anxiety

A
  • Occurs in children 6 years of age and older
  • Will function fine in comfortable enviromnet but will begin to experience anxiety and somatic complaints when leave
  • Comorbid with later anxiety and panic disorders
  • Tx is behavioral
  • Stranger anxiety is normal in cildren 12-18 months of age
245
Q

Pseudodementia

A
  • More rapid onset, patient knows something is wrong and answers I don’t know more often
  • Treatment is SSRI
  • If have to use TCA use nortryptaline
246
Q

MDD following grief

A

-After 6-8 weeks if symptoms are still present for 2 weeks can diagnose MDD

247
Q

Lewy Body and perkinsons dementia

A

-Do not treat with antipsychotics

248
Q

Sleep changes in elderly

A

Decrease total REM, decrease total sleep, decrease REM latencyt

249
Q

Delerium

A

Treatment is haldol

250
Q

Frontal lobe dementia

A

-Changes in personality are the first to occur

251
Q

Frontal lobe stroke

A

-Can induces snxiety, depression, psychosis

252
Q

Lewy Body

A

Can have waxing and waning symptoms. Be sure to differentiate with delerium as far as underlying disease and time course

253
Q

HIV

A

-Treatment with stimulants is often good because it will not take as long as SSRI to have antidepressive effects

254
Q

CJD

A

Wide array of dysfunction

  • Including basal ganglia and cerebeller dysfunction
  • Cortical blindness and mutism
255
Q

Substance abuse

A
  • Resolves are social and legal issues

- Defaultin on responsibilities, getting into trouble, problems with relationships

256
Q

Substance dependency

A

Resolves around physiologic effects and also if there is too much time spend acquiring. also mental health

257
Q

Tx of abuse

A
  • CBT, motivational interviewing, Group therapy (AA, NA)

- Also specifici mediation

258
Q

Benzos have the longest half life in urine

A

SOme can stay up to 30 days (diazepam)

259
Q

Alcohol

A
  • Causes increase in GABA, 5HT, decrease in Na channel and glutamate.
  • Treatment of intoxication is supportive of acidosis, electrolytes. Always give thiamine, and other vitamins often
260
Q

Alcohol Withdrawl

A
  • Siezures and physical symptoms start within 12 hours and go to 48. Full blown DT at 72 hours
  • Treat with benzos and monitor
261
Q

Alcohol dependence treatment

A
  • Disulfuram
  • Naltrexotne: Opiod
  • Acamprosate: Gaba agonist and glutamate antagonist
  • Topirimate: “”
262
Q

Cocaine

A

-DA reuptake inhibitor
-Can cause death by arrythmia, siezures, resp depression
-Vasoconstriction leads to MI
-Treatment is supportive and benzos/haldol if sgitated
Must cool if hyperthermic

263
Q

Cocaine withdrawl

A

Depression symptoms

-Hunger, anhedonia, anergia. Can cause suicidality

264
Q

Amphetamines

A
  • Cause release of NE, DA and inhibit reuptake

- Can lead to psychosis

265
Q

MDMA i

A
  • Type of amphetamine
  • Can cause seretonin syndrome
  • Symptoms of arousal
  • Renal failure
266
Q

PCP

A

Can cause flashback release from fat storesa

267
Q

Hallucinagens

A

Benzos and atypicals for psychosis

268
Q

Inhalants

A

CNS depressants

  • Arryhtmia, siezures, resp dperession
  • Decreased reflexes
269
Q

Mixed manic episode

A
  • Manic depressive

- Li and anticonvulsant (Carbemezapine, valproate)

270
Q

MDD

A

Decrease 5-HIAA in brain, increase in cortisol

-Commonly seen with pancreatic cancer

271
Q

Bereavment

A

-No therapy, or benzos for sleep short term only

272
Q

Rapid cycling

A

More than 4 episodes of mania and depression in one uear

  • More common in women
  • Use valproate
273
Q

Acute Mania

A

-Treatment is atypicals and lithium

274
Q

Dysthymia

A

2 years without MDD criteria

Cyclothymia is hypomania and not quite depression

275
Q

Minor depressive

A

Impaired functioning but less than 5 symptoms

276
Q

Adjustment treatment

A
  • Group therapy is best treatment

- If is MDD then is MDD

277
Q

Pyschosis

A
  • Always rule out drugs or medical condition
  • Post psychotic depression may occur
  • Often comorbid with substance abuse
278
Q

Neurobiology

A
  • Increase in DA in mesolimbic leads to positive symptoms
  • Decrease in DA in Prefrontal leads to negative symptoms
  • Treatment leads to blocked DA in nigrostriatal which can lead to EPS
279
Q

Typical Antipsychotics

A

-D2 receptors

Atypical work on D2 and also on 5-HT2

280
Q

S/E

A
  • Typicals are more likely to cause EPS

- low potency can cause anticholinergic

281
Q

Single psychotic episode

A

-Treatment for 6 months and then after that can taper off

282
Q

Brief psychotic

A

Treat only as aggresion and agitation dictate

283
Q

Delusionsl

A

Must last more than 1 month

  • Doesn’t impair functioning
  • Can treat with neuroleptic if necessary, but most spontaneously remit

Psychiatry Clerkship (2 decks)

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