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
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
3
Q
Depression with psychotic features
A
Psychotic features will only occur when there is a depressive episode
Treat with SSRI and antipsychotic
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.
5
Q
Dystonia
A
- Occurs acutely after the start of antipsychotic treatment (12 hrs), stuck in one position.
- Treat with Ach antagonists (Benztropine, Benadryl)
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
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
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)
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
10
Q
Benzo Withdrawl
A
- Mimics DT
- Treat with librium and ativan
- haldol if psychotic
11
Q
Specific Phobia
A
- Treat with flooding and desensitization
- Can give benzo in acute setting
12
Q
Performance Anxiety Only
A
Propranalol is first line
-Benzos are second line
13
Q
Social Anxiety
A
- SSRI, SNRI are first line
- Benzos can be used acute, but are not considered mainstays of therapy
14
Q
Avoidant Personality
A
- Hypersensitive of rejection
- Has few close friends
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
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
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
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
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)
20
Q
Munchausen
A
-Actually undergo painful, or unnecessary procedures
21
Q
Facticious
A
-Say you are sick, but are actually not
22
Q
Malingering
A
-Saying you are sick or injured for secondary personal gain
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
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
25
Refeeding syndrome
- Fluid retention
- Decreased phosphate, mag, Ca
- Can be deadly
26
Sleep
- 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
27
Insomnia
- First step is sleep hygeine
| - Next can try Z drugs, benzos
28
Restless leg syndorm
- Caused by Fe deficency anemia, renal disease, or neurtopathy
- First correct underlying problem
- Then can treat with Da agonists (ropinorole, pramipexole)
29
OSA
- Keep in differential for sleeping issues
| - Treat with CPAP
30
Narcolepsy
- Uncontrolled attacks of REM sleep often related to emotions
- Has hallucinations and loss of muscle tone
- Treat with scheduled modafanil
31
Schizoid vs Avoidant
Schizoid don't want friends. Avoidant want friends but don't have them
32
Schizotypal
- Have odd magical beliefs
- Often can appear schizophrenic because are disheveled and have strange ideas
- Lack true delusions and lack hallucinations
33
Antisocial
- OFten comes to kids with ODD, ADHD
| - Often are associated with substance abuse issues
34
Borderline
- Splitting is common feature
| - Unstable relationships and cutting
35
Histrionic
- Provacative
- Often hypersexual and have eating disorders
- Distinguish from borderline by lack of splitting, cutting, and UNSTABLE relationships
36
Dependent
-Often have comorbid depression or anxiety
37
Delerium
- 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
38
Alzhiemer's Dementia
- AB plauqes, tau tangles
- APP chromosome 21
- APO E
- Tx: ACHesterase inhibitors (donepazil, rivastigmine, galanimantine)
- Memantine glutamate NMDA receptor antagonists
39
Frontotemporal dementia
-Hypersexual, disinhibitied, apathetic
-Can treat with olanzapine
INtracytoplasmic silver staining
40
Lewy Body Dementia
- Alpha synuclein inclusions
- Hallucinations, shuffling gate
- Tx is Achesterase inhibitors, don't give L-DOPA or neuroleptics
41
Vascular Dementia
-Older, stepwise
42
Crutzfeld Jakobs
- Myoclonus
| - EEG will show triphasic bursts, sharp waves
43
Tertiery Syphilis
- Look for loss of sensation, argyll robertson pupil
- IV looking for bacteria
- Tx is IV penacilin
44
NPH
- Wacky Wobbly and Wet
| - Treatment is VP shunt
45
Personality Disoreders
A: Wacky (schizoid, schizotypal, paranoid)
B: Wild (Borderline, Histrionic, Narcassistic, antisocial)
C: Worried (Avoidant, OCPD, Dependent)
46
Personality Associations
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
47
Abuse
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
48
Dependence
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
49
Alcohol Addictoin
- Converted to aldehyde in liver and converted to acid
| - GABA agonist
50
Alcohol withdrawl
- 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
51
Alchol Dependence Treatment
- 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.
52
Alcohol problesm
- Wernicke encephalopathy: Opthalmoplegia, ataxia, confusoin
- Korsakoffs: Confabulation and anterograde amnesia worse
- Both are caused by decrease B1
53
Cocaine
- 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
54
Amphetamines
- 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
55
Ecstacy
- Considered under amphetamine
- Can precipitate seretonin syndrome
- LEads to excessive thirst
56
PCP
- 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
57
Sedative Hyptonitcs
- 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
58
Opiods
- 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
59
Hallucinagens
-LSD,
-PResentation can mimic stimulants
-No real physical dependence
-Can have flashbacks to hights
Treatment is supportive for agitated pschoise give benzos and haldol
60
Marijuanna
- Inhibits adenylate cyclase
| - Can have acute agitation and cna occur on withdrawl
61
Inhalants
- 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
62
Caffeine
- Adenosine antagonist leads to increase in cAMP
- Leads to increase DA
- Stimulant
63
Nicotine
- Nicotinic agonist and increase DA
- Treatment for addiction is nACHr partial agonist
- Varencycline
- Buproprion: Also inhibits DA uptake
64
Schizophreniform
-Symptoms that are part of schizoid personality disorder do not count towards time of 6 months.
65
Concrete thinking
Unable to abstract. Can't understand or explain metaphors
| -Seen in children, people with cognitive defects, and schizophrenics
66
Diagnosis of suspected MR
IQ test
67
Depression in Kids
- Often presents with acting out or with irritability
| - Becks can be given to diagnose in kids older than 13
68
Predictors of Violence
- Male, age 19-24, alcohol, low SES, acute stress
| - History
69
Care of a violent patient
- 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
70
Countertransference
- 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
71
HIV Dementia
- Look for in younger patients presenting with dementia
| - Seen more ommonly in patient with a CD 4 less than 200
72
Blocking
-Patient will stop in mid sentence and not be able to finish
73
Derealization vs Depersonalizatoin
- 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
74
Magical thinking
- 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
75
Nihilism
-Thought that the world is not real or the pateitn or people are dead/not real
76
Echolalia and Echopraxia
-Echolalia is spoken. Echopraxia is motions
77
Malignant Hyperthermia
-Increase Temp, acidosis, familial
78
NMS
Rigidity, recent started drugs, rigidity, altered conciousness. Not necessarily familial
79
Thyrotoxicosis
- Look for in post stressed patient (Pneumonia etc)
| - Hyperthermia, dysutonomia, emergent, etc
80
Seretonin Syndrome
- Hyperreflexia
- Shivering, diahrrea,
- Occurs when taking SSRI, MAOI, L-Tryptophan, ondansetron, opiods, etc
81
Hepatic encephalopathy EEG
-Triphasic bursts
82
Toxic Encephalopathy/delerium
-Background slowing
83
Stroke
-Laterializing periodic
84
Ericsonian 0-1
Trust vs mistrust
85
ERicosinian 1-3
Autonomy/confidence vs Shame/dount
86
Eric 3-5
Initiative vs guilt
87
Eric 21-40
Intamacy vs isolation
88
Eric 40-65
Generativity vs stagnation
89
Eric 65+
Integrity vs dispair
90
Eric 6-11
Industry vs Inferiority
91
Eric 12-20
-Identity vs confusion
92
Tardive
- Can switch to clozapine which has less likilhood
| - Can also use clonidine or tetrabenzaine
93
SSRI Birth Defects
- Can cause withdrawl symptoms in the newborn
| - Persistent Pulmonary HTN of the newborn is the most feared complication
94
SSRI discontinuation syndrome
- Paroxatine (Paxil) is most likely to cause
| - Fluoxetine is least likely
95
Interferes with lamotragine metabolism
-Oral contraceptives can decrease levels of lamotragine by effecting liver
96
Trazadone mechanism of action
- Blocks alpha, histamine, seretonin
| - Major indication is insomnia but also functions as an antidepressant
97
Lithium Cardiac effects
- Causes inverted or malformed T waves
| - Do not prescribe in any conduction defects
98
Lithium Renal Clearance Interference
- NSAIDs are the most common
- Diuretics are also common (HCTZ, K sparing)
- Also metronidazole and tetracyclines
99
TCA for OCD
-Clomipramine
100
Refractory OCD med
-Atypical antipsychotic added to SSRI or clomipramine
101
Orthostatic hypotension
- TCA, especially imipramine (Used for bedwetting)
| - Also antipsuychotics, except haldol
102
Combative Patients
- Always sedate first
| - If combative and delerious give haldol
103
Undoing
-The compulsive act that occurs as a result of intrusive fantaical thought
104
Child phases of detachment
- Protest
- Despair
- Permanent Detachment
105
Ideational Apraxia
Unable to do complex stepwise activities
106
Cataplesy
-The ability to maintain postures for long periods of time
107
Temporal Lobe Epilepsy
Intense emotions, perseveration in interactions, hyposexuality
-WIll also show abnormal EEG
108
Migraine Headache
5-HT1D
109
Depression
5-HT1A
110
Psychoisis
D2, site of 1st generation antipsychotics
111
Atypical antipsychotics
D4 and 5-HT6
112
Damage to prefrontal Cortex
Can change mood and affect. Right damage leads to happiness and left damage leads to sadness
113
Vitamin E excess
Causes disruptions in clotting and can lead to hemorrhage and stroke
114
2 Separate Neurologic Findings
Think MS first
115
ADHD Diagnostic Criteria
- Symptoms must have been present before age 12
- Symptoms present in 2 locations
- Symptoms present for more than 6 months.
116
Night Terror
- 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
Childhood Depression
- Irritability is a more common presenting symptom
| - More commonly associated with hallucinations or evidence of psychosis (1/3 of patients)
118
Alzhiemers is not frontal lobe dementia
-Will not show classic signs of loss of inhibition
119
Subdural hematoma
-Can cause a transient dementia like state in younger patients.
120
Generalized Siezure
- 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
Neuroleptics in delerium
- 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
Panic Disorder
- Occurs spontaneously
| - If it is provoked in a certain setting then it is likely a specific phobia (unless it is part of agoraphobia)
123
HIV Dementia
- Always keep in mind in younger patients
| - Will show volume loss and imaging changes on MRI
124
Wernicke Encephalitis
- Treat with Thiamine and can resolve
| - There is 6th nerve hyperactivit
125
Korsakoff Amnesia
- Is retrograde and anterograde
| - Often it is the anterograde that causes the confabulations
126
DT vs Delerium
-In DT there is likely more physiologic findings. There will also be no alternating with somnolence as is seen in delerium
127
Siezure Hormone
-Prolactin is increased in Siezures
128
Steroids
- Can cause all kinds of psych symptoms
| - Mood disorders including bipolar and depression are the most common
129
Brief Psychotic Episode
- 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
Drug causes of psychosis
-Cocaine, PCP, LSD
131
Signs of psychosis vs malingering
-Psychosis is most often auditory hallucinations. Visual hallucinations are more likely caused by medical condition (Alcohol) or malingering
132
Hyponatremia
- 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
Treatment of single psychotic epiosde
- If treatment is undertaken such as in schizo
| - If patient is symptom free for 3 years then can discuss the reduction in treatment
134
Terminal patients
- Delusions are most common (90%)
| - Depression and anxiety also occur at a large rate
135
Autoscopic hallucinations
-A ghost is following me
136
Capgrass
-Everyone has been replaced by their identical double
137
LYcanthropy
-Thought that you are turining into an animal (Werewolf
138
Cotard
- Everything about you is dead and lost
| - Lost money, house etc, even lost internal organs
139
Koro
Korean Shrinking penis
140
Amok
Malay violence
141
Dhat
Indian sexual dysfunction
142
Rest of cultureal
Psychosis
143
Dysthymia treatment
- Venlafaxine, buproprion first line
| - MAOI is second line
144
Effects of sleep on mood
- Anti-depressant
| - Mania inducer
145
Post Partum
- 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
SAD
- Criteria is not enough for MDD
| - Hyperphagia and hypersomnia are most common symptoms
147
Bipolar with depression
- Treat with lithium and SSRI for depressed episode
| - Taper off SSRI ASAP to prevent provoking mania
148
Disruptive Mood Dyregulation
- Irritability is the prominent feature
- Very common in kids
- Often is longer term in adults
- Doesn't meet criteria for MDD
149
When to treate Mood 2 to general medical condition
- 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
ECT
- Memory issues get all the credit
- HA, nausea are more common
- Contra is space occupying lesion or MI within 6 months
151
Augmentation of SSRI
- 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
GAD treatement
SSRI and busprion are both first line. If there are contrainditation to SSRI use busprione
153
Initial TX of panic disorder
-Use benzo with SSRI, taper benzo as SSRI effects come online (6 weeks)
154
Erection SE
-Of SSRI, fluoxetine is least likely, but bupurprion is still the best choice
155
Perphenazine
Can cause issues with ejaculation, not erection
| -Maybe similiar among other neuroleptics
156
Differentiate between OCPD and Narcisism
- Perfectionist and orderely freak is OCPD
- Narcisist will have anger with things other than orderliness
- Narrow in many presentations
157
Tx of Narcisism
-Difficult
| Psychodynamic will be most effective although all are not great
158
Primary Hypersomnia
Consider when all disorders of sleep have been ruled out in a patient with excessive daytime sleepiness
159
OCD vs OCPD
Be careful to determine degree of ego-syntonicism
160
Location of brain with mood disorders
Frontal lobe will show changes on fMRI
161
Li EKG
Flattenting of T waves and inverted U waves
162
Contraindications for Li
MI, MG, Renal disease, Diuretics, NSAIDs
163
Tx of Mania in first trimester of pregnancy
Clonazapam
164
Hepatitis in treated maniac
Valproate
165
SJ in maniac
Lamotrigine
166
Aplastic Anemia in Maniac
Carbemazapine
- Monitor weekly when WBC less than 2k
- DC when WBC less than 1 k
167
Depression first question
- SI
| - Never forget to ensure patients safety before treating
168
Sleep in depression
Decreased REM latency and overall increase in REM
169
Patients where venlafaxine should be careful
-Hypertensives
170
Treatment of tyramine/MAOI induced hypertensive crisis
- Phentolamine
| - Alpha blocker
171
TCA EKG findings
- 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
Schizophrenia Neurobiology
- Increase in DA in limbic circuits
| - Decrease in DA in meso-cortical, prefrontal (negative symptoms). Atypicals can make this worse
173
Schizoaffective disoreder
-Treat both psychosis (with neuroleptics) and depression (with SSRI)
174
Chlorpromazine
-Metalic rash in sun exposed areas
175
Thioridizine
-Pigmented retionpathy and increasd QT
176
Parkinsons
-Treat with anticholinergic, or bromocriptine. Do not give L-DOPA
177
Arirprazole
-Weight neutral, but causes akathesi
178
Quetipine
-Long QT, Orthostatics, cataracts
179
Benzos relative contraindications
-Restrictive Lung disease, COPD
180
OCD Treatment
Chlomipramine is approved SSRY
| Otherwise use SSRI
181
Anorexia
- Must decifer using BMI
- Treatment is aggressive nutritional therapy and counseling
- Bulemia is SSRI
182
Refeeding Syndrome
-Low Phosphage, Mg, Ca, fluid retention
183
Anorexia Diagnosis
- Everything is low. Leukopenia, Bradycarida, hypothermia
- Amylase high
- K, Cl low. Bicarb high
- Hypercholesterolemia
- Increased carotene and LFT
184
RLS
- Look for Fe deficency anemia or renal disease
| - Treatment is ropinorole or pramipexole
185
Paranoid PD
- 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
Condunct
-Must diagnose in the history of ADHD
187
Alzhiemers Tx
- AcheI: Donepazil, galantamine, rivastigmine
| - Memantine is Glutamate antagonist
188
Frontotemproal
- Silver stained intranuclear inculsions
- Sexually explcicit
- Can give olanzapine to depcrease sexual comments
189
Lew Body
- Hallucination
- Parkinson features
- Can treat with AchE inhibitors
- Do not give L-DOPA or neuroleptics
190
Alcohol Withdrawl
- 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
Etoh specific test
- Carbohydrate deficent transferrin is most specific
| - GGT is also goof
192
Amphetamine Treatment
Treat cardiovascular effects with Ca channel blocker no beta blocker
193
Diagnosis of ADHD
-Requires 2 settings. Symptoms only reported by parents are not enought
194
Methylphenadate
-DA reuptake inhibitor
195
Amphetamine
-DA, NE reuptake inhibitor and causes release
196
Atomoxatine
- NE reputake inhibitor
| - Not an amphetamine
197
ADHD others
-Can also give clonidine or guanfacin
198
Tourettes
- 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
Rumination disorder
Check lead levels
200
Alcohol withdrawl hallucinations
-Treatment with benzos will treat both. Only give haldol if patient is a agitated
201
Terminal illness depression
-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
Huffing symptoms
- HA, depressed reflexes
| - Treatment is absitence
203
Mood stabilizer that causes hairloss
-Depakote. Divalproex
204
Treatment resistant ADHD
-If one class of stimulant doesn't work then try the other
205
Treatment during pregnancy
- Psychosis: Haldol
| - Mania: Benzos (Ch)
206
Somatoform disorders
- Somatization
- Pain
- BDD
- Conversion
- Hypocondriasis
- Facticious
- Malingering
207
Somatization
- 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
Pain Disorder
- Pain is the predominant symptom
- Analgesics don't help
- Can be exacerbated by depression
- Tx: SSRI, Biofeedback
209
Conversion
- Neurologic symptom
- Often preceded by psychological stressor
- Tx: Insight directed psychotherapy
210
Hypochondriasis
- 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
Factitous
-Concisouly producing symptoms for primary gain
212
Malingering
-Conciously producing symptoms for secondary gain.
213
Dissociative amnesia
- 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
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Fugue
- 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
Depersonalization
-Feeling detached from person
216
Ganser
-Approximate answers
217
Ataque de Nervios
-Hispanic trance culturally bound syndrome
218
Impulse Control Disorders
- 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
Intermitent explosive
- Anger outbursts with remores
| - Treatment is SSRI, propranolol, Li
220
Kleptomania
-Highly correlates to OCD and eating disorders
-Highly remorseful
Tx with SSRI, exposure therapy
221
Pyromania
- 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
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Anorexia
- 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
Bulemia
- 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
Binge Eating
No concern with body weight
-Treatment is CBT and weight loss often times
2x/wk for 6 months
225
Dysomnias
- 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
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OSA
-CPAP
227
Narcolepsy
- Catalplexy, etc
- Treatment is modafanil or stimulants
- Also frequent naps
228
Circadian rythm disorders
- 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
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Primary hypersomnia
-Rare
230
Klein Levin
-Primary hypersomina with hyperphagia
231
Parasominas
- Unusual behaviors
- Best treatment is to keep area safe
- Can use benzos in refractorty cases
232
Types
Sleep terror
REM sleep (Walking, kicking etc)
Nightmare (Can us IRT)
Risk is increasd in all with age and psychotropic medication
233
Sexual Psych
- 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
MR Causes
-Anoxia, downs, Fragile X, Kernicterus,TORCHES
235
Learning Disability
- Problems with learning and school functioning even though normal IQ, Education, Development
- Always check sensory defecits
236
ODD
-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
Conduct
- 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
ADHD
- Must be diagnoised with input from 2 scenarios
| - Can be caused by Pb poisoning or from smoking during pregnancy
239
PDD
- Autism specturm
- Impaired communication, language, and procupation with certain things
- Make sure to check hearing and sensory functions
240
Rett
- 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
Tourettes
- 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
Elimination
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
Selective Mutism
- 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
Separation Anxiety
- 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
Pseudodementia
- 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
MDD following grief
-After 6-8 weeks if symptoms are still present for 2 weeks can diagnose MDD
247
Lewy Body and perkinsons dementia
-Do not treat with antipsychotics
248
Sleep changes in elderly
Decrease total REM, decrease total sleep, decrease REM latencyt
249
Delerium
Treatment is haldol
250
Frontal lobe dementia
-Changes in personality are the first to occur
251
Frontal lobe stroke
-Can induces snxiety, depression, psychosis
252
Lewy Body
Can have waxing and waning symptoms. Be sure to differentiate with delerium as far as underlying disease and time course
253
HIV
-Treatment with stimulants is often good because it will not take as long as SSRI to have antidepressive effects
254
CJD
Wide array of dysfunction
- Including basal ganglia and cerebeller dysfunction
- Cortical blindness and mutism
255
Substance abuse
- Resolves are social and legal issues
| - Defaultin on responsibilities, getting into trouble, problems with relationships
256
Substance dependency
Resolves around physiologic effects and also if there is too much time spend acquiring. also mental health
257
Tx of abuse
- CBT, motivational interviewing, Group therapy (AA, NA)
| - Also specifici mediation
258
Benzos have the longest half life in urine
SOme can stay up to 30 days (diazepam)
259
Alcohol
- 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
Alcohol Withdrawl
- Siezures and physical symptoms start within 12 hours and go to 48. Full blown DT at 72 hours
- Treat with benzos and monitor
261
Alcohol dependence treatment
- Disulfuram
- Naltrexotne: Opiod
- Acamprosate: Gaba agonist and glutamate antagonist
- Topirimate: ""
262
Cocaine
-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
Cocaine withdrawl
Depression symptoms
| -Hunger, anhedonia, anergia. Can cause suicidality
264
Amphetamines
- Cause release of NE, DA and inhibit reuptake
| - Can lead to psychosis
265
MDMA i
- Type of amphetamine
- Can cause seretonin syndrome
- Symptoms of arousal
- Renal failure
266
PCP
Can cause flashback release from fat storesa
267
Hallucinagens
Benzos and atypicals for psychosis
268
Inhalants
CNS depressants
- Arryhtmia, siezures, resp dperession
- Decreased reflexes
269
Mixed manic episode
- Manic depressive
| - Li and anticonvulsant (Carbemezapine, valproate)
270
MDD
Decrease 5-HIAA in brain, increase in cortisol
| -Commonly seen with pancreatic cancer
271
Bereavment
-No therapy, or benzos for sleep short term only
272
Rapid cycling
More than 4 episodes of mania and depression in one uear
- More common in women
- Use valproate
273
Acute Mania
-Treatment is atypicals and lithium
274
Dysthymia
2 years without MDD criteria
| Cyclothymia is hypomania and not quite depression
275
Minor depressive
Impaired functioning but less than 5 symptoms
276
Adjustment treatment
- Group therapy is best treatment
| - If is MDD then is MDD
277
Pyschosis
- Always rule out drugs or medical condition
- Post psychotic depression may occur
- Often comorbid with substance abuse
278
Neurobiology
- 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
Typical Antipsychotics
-D2 receptors
| Atypical work on D2 and also on 5-HT2
280
S/E
- Typicals are more likely to cause EPS
| - low potency can cause anticholinergic
281
Single psychotic episode
-Treatment for 6 months and then after that can taper off
282
Brief psychotic
Treat only as aggresion and agitation dictate
283
Delusionsl
Must last more than 1 month
- Doesn't impair functioning
- Can treat with neuroleptic if necessary, but most spontaneously remit
