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Exam 2 Beth Flashcards

1
Q

Screen everyone even low risk

A

Har from false positive-expense, harm , and mental trauma

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2
Q

Mood disorders

A

Ok

Depressive, anxiety, and bipolar related

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3
Q

Mood disorders genetic

A

Can be-always get family history

Especially bipolar-50% have a first degree relative with a mood disorder
-LOOK FOR FAMILY HISTORY WITH BIPOLAR

10-25% of mood disorder have first degree relative for mood disorder

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4
Q

NT with mood

A

NE, dopamine, 5-HT, GABA , glutamate

Glutamate NMDA-excitatory

GABA-inhibitory NT, site of benzodiazepines
Dopamine down in depression, high in mania

NE down regulate beta receptors, nor Adrenergic function abnormal in depression

5-HT decreased in depression SSRI proved effective as anti depression

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5
Q

Life and environmtal psychocosial

A

Death grandparent, parent before 11, death spouse or child, unemployment,

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6
Q

Major depressive

A

2 weeks at least 5 with at least 1 being depressed mood or loss of interest or pleasure

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7
Q

Manic

A

Abnormally and persistently elevated expansive or irritable mood lasting at least 1 week with at least 3 of the following

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8
Q

Hypomanic episode

A

Similar to manic last 4 days must not include psychotic features

BIPOLAR TYPE II associated

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9
Q

Diagnosis major depressive disorder

A

Diagnosis requires presence of one or more major depressive episodes and absence of manic, hypomanic, or mixed

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10
Q

Grief (bereavement) vs depression

A

Grief 2 months-2years

Following loss of a lover one , symptoms similar to major depressive, should not include hallucinations/delusions or impairment of function

NO HALLUCINATIONS?DELUSIONS or impairment of function

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11
Q

Kubler Ross stage of grief

A

Denial Anger depression bargaining acceptance

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12
Q

Treat grief

A

Not antidepressants

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13
Q

Treat major depressive disorder

A

hospitalization

Somatic therapies=TCA, MOA inhibitors, SSRI, SNRI, mirtazapine

ECT

Trans racial magnetic stimulation

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14
Q

Triazolopyridines trazadone

A

Priapism
Cheap
Help sleep
Don’t use

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15
Q

ECT

A

Treatment resistant depression

Short term memory loss common

Good treatment response

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16
Q

Transcranial magnetic stimulation

A

Newer treatment in doctors office

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17
Q

Ketamine

A

Causes dissociative anesthesia
NMDA antagonist

Overdose-panic attacks and aggressive

Works well AMAZING

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18
Q

Spravato

A

Nasal ketamine like

Nasal spray given in health care setting NO GO HOME rapid acting antidepressant

$$$$$$$$$$

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19
Q

Persistent depressive disorder/ dysthymic

A

Depressed mood for most of day for 2 years in duration for adults and 1 year for kids that has not been severe enough to meet criteria for major depressive episode

During 2 years cannot be w/o six for >2 months at a time

Smoldering depressed

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20
Q

Treat dysthymic

A

SSRI, SNRI, MAOI, CBT

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21
Q

Seasonal depression

A

Onset and remission of major depressive episode at characteristic time
Fall

Sleep more and eat more fatigues

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22
Q

Treat seasonal depression

A

Light therapy

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23
Q

Premenstrual dysphoric disorder

A

Moor instability 1 week before menses for 1 year

Treat with exercise, diet, relaxation,

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24
Q

Bipolar 1

A

At least one manic or mixed episode and a depressive

Don’t need a major depressive episode
To diagnose, if have a manic call them this
Worse prognosis MDD

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25
Q

Bipolar II

A

At least 1 major depressive and one hypomanic more common than I

NO MANIC

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26
Q

Treat bipolar

A

Lithium, valorous acid mood stsabilizers

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27
Q

Cyclothymic disorder

A

Dysthymic disorder with intermittent hypomanic periods

Over 2 years (1 for kids), experiences repeated episodes of hypomanic and depression (not severe enough to meet criteria for major depressive disorder)

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28
Q

Treat cyclothymic disorder

A

Mood stabilizing
Antidepressants precipitate manic-diagnose bipolar from giving an antidepressant
Support

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29
Q

Substance related

A

Bipolar and major depressive disorders either due to substance induced or withdrawal of drugs

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30
Q

Anxiety disorder symptoms psychological

A

Apprehension, worry, doom gloom, hyper vigilant (also PTSD) ,cant concentrate, derealization

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31
Q

Somatic symptoms anxiety

A

HA, dizziness, lightheaded, palpitations, lump in throat , restlessness, SOB, dry mouth, sweating

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32
Q

Physical signs anxiety disorders

A

Diaphoresis, cool clammy skin, tachycardia, flushing, hyper reflex is, tremor, fidgeting

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33
Q

Generalized anxiety

A

Everything in general bothers u

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34
Q

Panic disorder

A

Recurrent unexpected panic stacks

At least one attacked followed by 1 months or one or more
-persistent concern about additional attacks
Worry about implications of attack or its consequences
Significant change in behavior related to the stack

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35
Q

Panic atttack

A

Discrete period of intense fear or discomfort, in which four or more of the rolling g develop PEAK IN 10 min

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36
Q

Who has panic disorder

A

Women

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37
Q

Agoraphobia

A

Situations cant get out by scared gonna have a panic attack so stay home

Associated with panic disorder

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38
Q

Social phobia

A

Avoid social situations for about 6 months
Feel embarrassed or humiliated/uncomfortable when talking to others

Feel they’re hanging on every word

Shy kids being teased=worry about talking to you

If patients this social anxiety

Usually starts 3-5th grade shy kids can get social phobia

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39
Q

Social phobia hand shake

A

Super wet hand scared about interaction

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40
Q

Generalized anxiety disorder

A

Excessive anxiety and worry (apprehensive expectation) occurring more days than not for at least 6 months, for most day, about a number of events or activities

Difficult to control the worry

The anxiety and worry are associated with at least 3 for 6 months 
-restlessness or feeling on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
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41
Q

OCD

A

Recurrent and persistent thoughts, impulses, or images experienced as intrusive and inappropriate and causing marked anxiety or distress

Not simply excessive worries about real like issues

Person attempts to ignore or suppress these thoughts

Recognizes them as a produce of mind

Compulsions-repetitive behaviors or mental acts, aimed at preventing or reducing distress

Recognized obsessions or compulsions unreasonable

Obsessions and compulsions interfere with functioning

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42
Q

OCD vs ersonality disorder

A

OCPD-don’t know have problem

OCD-know their compulsion and obsessions re not reasonable most of the time

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43
Q

ptSd

A 
Re experience traumatic event
Avoidance
Increased arousal
Nightmares
Flashbacks

Negative cognitions-persistent and disrobed sense of blame or self or others, estrangement from others, markedly diminished interest in activities, inability to remember key aspects

HAS OT BE FOR OVER A MONTH

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44
Q

Acute stress disorder

A

Less than 1 month

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45
Q

Treat PTSD

A

SSRI
CBT
Increased risk of substance abuse
-avoid addictive Rex such as benzodiazepines

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46
Q

Arachnophobia

A

Spiders

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47
Q

Iatrophobia

A

Fear of doctors

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48
Q

Acrophobia

A

Fear of heights

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49
Q

Treat anxiety w

A

Supportive therapy
Psychodynamic psychotherapy
CBT

SSRI***** serotonin anxiety NT, SNRI, TCA, MAOI, buspirone, benzodiazepines, antipsychotics

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50
Q

Eating disorders

A

Suicidal

Bulimia and anorexia

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51
Q

Anorexia

A

Restriction of energy intake lower body weight don’t think anything is wrong with them

Distorted perception fo body weight and shape undue influence of weight and shape on self worth or denial of the medical seriousness of ones body weight

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52
Q

Types of anorexia N

A

Restricting type

Binge eating purging type

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53
Q

Restricting type

A

3 months of no binging or purging

Excessive exercise, fasting, dieting

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54
Q

Binge eating purging type

A

4 months of binging and purging behavior

Self induced vomiting , misuse of laxatives, diuretics, enemas

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55
Q

Binge eating purging not bulemia

A

NOT OVERWEIGHT in anorexia N binge eating type

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56
Q

AN

A

Not delusional it is their reality

Deny conceal or express through somatic or old symptoms

Dress a way to hide weight loss

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57
Q

Complications AN

A

Cardiac-bradycardia hypotension QT dispersion, cardiac atrophy and mitral valve prolapse

Amenorrhea, decreased libido

Osteoporosis

Gastroparesis and constipation

Dehydration, hypokalemia, hypophosphatemia, hypomg

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58
Q

AN medical complications

A

Respiratory muscle atrophy

Anemia, leukopenia, thrombocytopenia,
Brain atrophy

Ceros is, lanugo, carotenoid Emma, acrocyanisis, seborrheic dermatitis,

Re feeding syndrome-DO NOT rehydrate or feed beyond capacity this is serious complication

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59
Q

Comorbidity AN

A

OCD anxiety disorders

Impulse control

Personality disorders
Obsessive-compulsive, avoidant, dependent, narcissistic, paranoid, borderline

Perfectionist, narcissistic

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60
Q

Treat AN

A

Interdisciplinary team , rehab psychotherapy, ALWAYS ASK ABOUT SUICIDALITY, what

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61
Q

Pharm AN

A

Antidepressants gain weight

Start low doses due to increased risk of side effects

Avoid bupronion** by increase seizure risk with binging and purging and TCA for cardio toxicity

Caution with antipsychotics and antidepressants with risk of QT prolongation

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62
Q

BN

A

Recurrent episodes of binge eating,eating a lot
Not underweight

Recurrent inappropriate compensatory behavior

Sel evaluation is unduly influenced by body shape and weight

Disturbance does not occur exclusively during an AN

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63
Q

Considerations BN

A

Depressed, conceal binge eating and purging, fearful of weight gain, don’t necessarily want to be thin bu don’t want to be fat

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64
Q

Medical complications BN

A

Dehydration, hypokalemia, hypochloremia, metabolism alkalosis

Mallory Weiss syndrome, calluses on back of hand, esophageal rupture, parotid and submandibular gland hypertrophy, abdominal pain and bloating and constipation

Tooth enamel erosions

Parotid big by salivating

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65
Q

Comorbidity BN

A

Anxiety, mood , substance disorder

Treat those

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66
Q

Treat BN

A

CBT, pharmacotherapy,

Monitor for medical complications

Nutritional rehab is used to help counsel patients about eating habits to help control

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67
Q

CBT BN

A

Other ways to cope with dysphoria

Helps!

Best when combined with pharmacotherapy y

Improve self esteem

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68
Q

BN pharmacotherapy

A

Less effective than CBT alone, but best if used in combination**

Avoid bupropion

SUICIDALITY always when start on antidepressant

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69
Q

Black box warning 18-24 antidepressants

A

Suicide

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70
Q

Pharmacotherapy BN

A

Fluoxetine SSRI* first line

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71
Q

Flyvoxamine

A

OCD and second line BN

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72
Q

Binge eating disorder

A

Episodes of binge eating in a 2 hour period and cant stop eating and feel lack of control
Rapid, not hungry, eat alone, disgust after binge eating

Episodes occur on average for once a week for at least 3 months!

No regular compensatory behavior

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73
Q

Treat BED

A

CBT, focuse on earth coping skill, deal with body image

Vyvanse(lisdexamfetamine dimesylate) is the first and only medication approved to treat moderate to severe binge eating disorder in adults also indicated for ADHD

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74
Q

Pharmacotherapy BED

A

Less effective than psychotherapy , but less expense and time

Psychotherapy best bet

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75
Q

Gender dysphoria

A

Gender in congruence

Strong desire to be another gender in kids

Adults-desire to rid of ones sexual characteristics I, desire to be other gender, desire to be treated as other gender

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76
Q

Treat gender dysphoria

A

Multidisciplinary approach

Access to high quality

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77
Q

Treat gender dysphoria

A

Not meds
Talk, therapy so become comfortable in skin

Transfer of patients from adolescent to adult services is important

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78
Q

Geriatric psychiatry

A

Now dsm5 shows mild cognitive impairment-go into room forget why in there

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79
Q

Dsm5 changes

A

Mild cognitive impairment along with major

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80
Q

modest cognitive decline

A

Just change and ppl notice but doesn’t interfere with capacity of life

See more but not debilitating

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81
Q

Special considerations when treating geriatric patients

A

Multiple comorbidities
Unusual presentation of illness

More degenerative. Diseases and cancer
Differentiate normal aging from disease

Under reporting

Purpose of treatment

Medication start low and go high

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82
Q

Lewy body dimentia

A

Progressive disorder-neurocognitive deficits, memory, learning new things but also parkinsons like symptoms shuffling rigid falling and severe memory problems and visual hallucinations

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83
Q

Risk factor Alzheimer’s

A

Female, family history, head trauma, downs

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84
Q

Dementia reversible causes

A

Drug induced, thyroid, metabolic disorders, hematoma, hydrocephalus

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85
Q

Symptoms dementia

A

Depression

Memory loss
Sadness
Social withdrawal
Disorientation
Personality changes
Inappropriate behavior 
Psychotic symptoms
Agitation
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86
Q

Pseudodementia

A

Problems depression but there is something else going on, not a 6 moth progressive illness

Get depression under control and memory gets better!
Depression presents as memory loss

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87
Q

Most important dementia

A

H and P
For progression, comorbidity, neurological, mental exam, functional status, neuropsychological testing, labs-b12, folate, CBC, camp, hba1c, ct mri, pet

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88
Q

Neuropsych testing

A

If on fence and done mental status exam and family says cognitive decline
Impulsive, erratic, and memory isn’t too bad

Want to get a baseline of how bad memory is11 neuropsych testing on fence with anything of any psychiatric diagnosis

Closes thing to a blood test

BASE LINE neurocognitive funciton

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89
Q

B12

A

Numbness ataxic fatigue depressed

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90
Q

Pet scan

A

For diagnosing dementia but insurance rarely cover it

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91
Q

Treat dementia

A

Case treat
Rule out otherpsychiatric and Neuro conditions

Avoid anticholinergic medications which can impair cognitive function, especially in elderly (benadryl, hydroxyzine)** horrible on cognition

These meds slow progression and no cure. -donepezil acetylcholinesterase inhibitor, memantine NMDA antagonist

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92
Q

Treat psychosis in dementia

A

Antipsychotics
But black bock in psychosis in elderly patients with dementia

Olanzapine, aripiprazole, risperidone, quetiapine

Increase risk of sudden death -just says isn’t his pop twice likely for sudden death

These patients advanced dementia and medically compromised anyways but this is on all drugs packages

Start lowest dose shortest period of time possible by will get Parkinson’s

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93
Q

Psychosis due to delirium

A

Third most common cause of psychosis in elderly outpatients

And high risk mortality in delirium for 1 year

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94
Q

Delirium

A

Visual hallucinations and disoriented and happens over night or a few days

Dementia months

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95
Q

UTI and delirium

A

Septic

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96
Q

Constipation and delirium

A

Totally

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97
Q

Psychosis due to major depressive disorder with psychotic features

A

Psychosis in old

Somatic troubles, persecution, depressed

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98
Q

Treat psychotic depression

A

ECT

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99
Q

Treat psychosis due to Alzheimer’s type dement

A

Antipsychotics

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100
Q

Psychosis due to Alzheimer’s type dementia

A

Most common diagnosis accounting for psychosis in old

Believe spouse is cheating on them

Paranoid

Patients believe items stolen from them
Abandoned

Their spouse and children are disloyal to them

Usually delusions of paranoid nature

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101
Q

Substance abuse

A

Old prone to abuse prescription drugs and alcohol

Why do physicians miss substance abuse in old???

Unaware of the high prevalence rate

Unaware of increased impact certain substances have on the elderly
Uncomfortable-doctors Amy not be comfortable in screening elderly

Maintain a high index of suspicion When popping pills of drinking a lot and always ask about it

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102
Q

Risk factors for substance abuse in elderly

A

Female, single separated, absence of hobbies, health concerns, possible pharmacokinetic changes that take place in older individuals may lead to an increased potential for abuse of benzodiazepines or opiates

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103
Q

Long use of substances like benzodiazepines

A

Fall, cognition impairment, depression and other mood alterations, sleep alteration, balance and vestibular problems, delirium, increase risk for developing other medical conditions

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104
Q

Lorazepam old person

A

Delirium and confusion

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105
Q

Treat substance abuse in old

A

Treat withdrawal

Can’t go cold turkey with intense-alcohol, benzos and barbiturates can kill u if u do this

Alcohol->delirium tremendous and death

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106
Q

How go off alcohol barbiturates and benzodiazepines

A

Gradual taper is also an effective way to treat benzodiazepine dependence in older persons

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107
Q

Treat alcohol withdrawal

A

Benzodiazepines (diazempan)

Gabapentin and valorous acid

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108
Q

Treat substance abuse in older

A

Inform patients! This increases compliance!

More education less medication

Educate about what’s going on

CBT 12 step program

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109
Q

Is depression common in old ppl

A

Yup

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110
Q

Primary causes depression

A

Deteriorating health
Cognitive decline
Loss of independence
Loss of spouse and friends

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111
Q

Signs symptoms depression old

A

Anxiety, fatigue and hypersomnolence, somatic complaints, cognitive impairment, weight loss, insomnia , anhedonia, agitation, less evident symptoms in the affective mood domain

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112
Q

Major depression meds

A

Not one indicated

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113
Q

Are you a burden to your family

A

Red flag for suicide

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114
Q

Avoid diphenhydramine in old

A

Serotoninsyndrome

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115
Q

Dementia vs depression

A

Depression have insite are of memory loss goo thin

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116
Q

Treat depression

A

CBT SSRI-but worry hyponatremia and insomnia

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117
Q

Mirtazapine

A

Increases appetite

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118
Q

SSRI

A

Falls, GI, serotonin syndrome

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119
Q

Bupronion

A

Seizures

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120
Q

TCA

A

Caution cardiac

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121
Q

Venlafaxins and fluoxetine

A

Often used with comorbidity pain conditions

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122
Q

Nortriptyline

A

Amazing TCA use caution inc radial though

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123
Q

Mesolimbic

A

Positive symptoms

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124
Q

Mesocortical

A

Negative symptoms

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125
Q

Nigrostriatal pathway

A

EPS and TD

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126
Q

Tuberoinfundibular pathway

A

Hyperprolactinemia

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127
Q

Indications for antipsychotics

A 
Psychosis 
Suicidal behavior (clozapine)

MDD
Bipolar, Tourette’s,

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128
Q

First generation antipsychotics/typical

A 
Chlorpromazine
Fluphenazine
Haloperidol
Thioridazine
Thiothixene
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129
Q

Second generations ntipsychotics/atypical

A 
Aripiprazole
Clozapine
Olanzipine
Quetiapine
Risperidone
Ziprasidone
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130
Q

Main difference between agent groups

A

Reduction in movement disorder SE

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131
Q

First generation MOA

A

Block dopamine type 2 D2 post synaptic receptors

D2>5HT2

Also muscarinic receptors, histamines receptors, alpha Adrenergic receptors, which cause SE

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132
Q

Muscarinic effects

A 
Dry mouth
Constipation
Urnary retention
Blurred vision
Sedation
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133
Q

Alpha Adrenergic effects

A

Orthostatic hypotension

Dizziness/syncope

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134
Q

Histamine receptors

A

Sedation

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135
Q

Other effects typical antipsychotics

A

QT prolongationa nd seizure

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136
Q

Dopamine associated AE first gen

A

Hyperprolactinemia (tuberoinfundibular)
-amenorrhea/galctorrhea/gynecomastia/decreased libido
Extrapyramidal symptoms /tar dive dyskinesia (nigrostriatal)

Acute aka this is/dystopia/Parkinsonism like
Tar dive dyskinesia

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137
Q

Low potently first gen

A

More sedation, hypotension and seizure threshold reduction

Chlorpromazine
Thioridazine

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138
Q

High potency are

A

More movement and endocrine

Fluphenazine
Haloperidol
Thiothixene

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139
Q

Treat dopamine associated AE for extrapyrimidal symptoms

A

Anticholinergic agents-benztropine and trihexyphenidyl

Antihistamine-diphenhydramine (Benadryl)

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140
Q

Treat tar dive dyskinesia

A

Selective vesicular monoamine transporter 2 inhibitor

Valbenazine
Deutetrabenzaine

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141
Q

Second generation MOA

A

Block D2 and 5HT2a

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142
Q

Name 2nd gen

A 
Aripiprazole
Clozapine
Olanzapine
Quetiapine
Risperidone
Ziprasidone
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143
Q

Do 2nd gen block more D2 or 5HT2a

A

5HT2a

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144
Q

MOA 2nd gen

A

5HT2a antagonism in PFC theorized to increase DA transmission in mesocortical path
May contribute to improved negative and cognitive symptoms
Reduced ep she

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145
Q

Side effects 2nd

A

Diabetes, weight gain, CVD, dyslipidemia

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146
Q

Rare at 2nd gen

A

QT prolongation ecg changes
Negative inotropic actions
-greater risk for women, old and on antiarrhythmics**

Stroke
-greater risk in elderly with dementia (increase all cause mortality with all antipsychotics)

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147
Q

Clozapine AE rare

A

Agranulocytosis

Monitor WBC, REMS program

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148
Q

Olanzapine AE

A

Drug induced hypersensitivity

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149
Q

Antipsychotics NMS

A

Rare fatal, severe Parkinson’s like

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150
Q

Treat NMS

A

Dantrolene

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151
Q

Dantrolene MOA

A

Block ryanodine receptor and get peripheral muscle relaxation

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152
Q

Antipsychotics moniting

A

Guidelines recommend determining in all patients a few things

-serum glucose, lipids, weight , blood pressure, waist circumference and personal/family history of metabolic and CV disease

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153
Q

What is critical for antipsychotic drugs

A

Adherence!

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154
Q

Non adherence antipsychotics how fix

A

Long acting injectable agents can manage
LAIA
Risperidone, olanzapine, aripiprazole, paliperidone

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155
Q

How long get effects antipsychotics

A

2-3 weeks

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156
Q

Max benefit (remission)

A

Several months

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157
Q

After dose escalation or switching agents, combination antipsychotic therapy may be necessary clinciallly

A

Acute agitation-injectable and ODT or SL versions

MDR -clozapine

Psychotic with antisuicidal thoughts
-clozapine

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158
Q

LO

A

Key features of psychosis and characteristic symptoms of schizophrenia

Epidemiology, etiologies, neurophysiology of psychotic disorders
Guidelines for management
Diagnostic criteria

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159
Q

Schizophrenia

A

Many disorders

Positive symptoms better prognosis
Negative symptoms poor prognosis
Very poor: negative symptoms, poor cognitive younger, poor support

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160
Q

Prodromal symtpoms

A

Before or few close friends, schizoid , minimal social activities

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161
Q

Schizophrenia etiology

A

In monozygotic only40-50%

Multiple genes, epigenetics, early life complications, labor delivery and neonatal life

1.5-2 fold increase for early life complication

Genes and env

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162
Q

So what drive schizophrenia

A

Integration between genomic risk and ELC driven by fetal genome and independent of gene-env interactions

Genes highly and differentials expressed in placenta drive the interaction between polygenic risk scores esp resp infections

Influenza virus during 1st trimester more likely to get this

163
Q

Maternal URI

A

Yes schizophrenia

Mom get flu shot omg

164
Q

Dopamine and schizophrenia

A

Mesolimbic areas and hypoactive dopamine transmission in prefrontal cortex

Dopamine also dysregulates brain regions including amygdala and prefrontal cortex which are important for emotional processing

165
Q

PET scan schizophrenia where hyperactive

A

Mesolimbic-hippocampus

166
Q

Positive symptoms

A

Delusions, hallucinations, disorganized thinking, grossly disorganized or abnormal motor behavior

167
Q

Negative symptoms

A

Diminished emotional expression-poor response to treatment

Abolition-poor response to treatment

Alogia

Anhedonia

Asociality

168
Q

Nihilism delusion

A

Belief things aren’t real

169
Q

Most common schizophrenia hallucinations

170
Q

Hypnagogic and hypnopompic

A

Not psychosis, or schizophrenia

Narcolepsy, related to temporal lobe dysfunction, seizure activity

171
Q

Types of disorganized thinking

A

Tangential
Derailment
Incoherent word salad

172
Q

Catatonic behavior

A

Decreased reactivity to env

Put arm somewhere and stays there

173
Q

Catatonic excitement

A

Purposeless and excessive motor activity without obvious cause

Walking around eating from dumpster lack of interaction

Presume schizophrenia

174
Q

Negativism

A

Resistance to instructions

175
Q

Inappropriate bizarre posture

176
Q

Mutism and stupor and repeated stereotyped movements

A

Year all of the schizophrenia out on the stress

177
Q

Negative symptoms

A

Alogia-diminished speech

Anhedonia-decreased ability to have pleasure
Asociality-lack of interest in social interactions

178
Q

Main neg symptoms

A

2 neg symptoms-dismissed emotional expression, abolition

179
Q

Neg symptoms

180
Q

Diagnose schizophrenia

A

2 or more for 1 month at least one the first 3

Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms

Kid not achieving function and adult going down hill

But these signs and symptoms must go on for 6 months -must get 1 month of criterion a , 1 month needs prominent

181
Q

What rule out for schizophrenia

A

Autism, neurodevelopment disorders and other things

182
Q

Catatonic type of schizophrenia

A

At least 2:
Motoric immobility as evidenced by catalepsy or stupor

Excessive motor activity (apparently purposeless and not influenced by external stimuli)
Extreme negativism or mutism

Peculiarities of voluntary movement such as posturing, stereotyped movements, prominent mannerisms or prominent grimacing, exholalia or achopraxia

183
Q

Echolalia

A

Repeat stuff that u say

184
Q

Schizophrenia and suicide

A

5-6% commit suicide

Single leading cause of death in them
Greatly increased with substance use, comorbidity major depression and previous high functioning

Usually near illness onset

185
Q

Work up schizophrenia

A

Labs, drug screen, imaging, ct/mri, neurological, eeg

186
Q

Delirium

A

Acute medical illness affects the brain, with psychotic symptoms

Consider with schizophrenia onset

187
Q

Mood disorders may mistake schizophrenia

A

Manic, major depressive, psychotic, schizoaffective

188
Q

Treat acute psychosis

A

Hospital if needed for patient safety and stabilization may need court order

IM injections for haloperidol, fluphenazine, lorazepam

189
Q

Treat stabilization phase

A

Consider converting to newer atypical antipsychotics

190
Q

Treat aintenance phase

A

Keep patients free from symtpoms while avoiding incapacitation side effects

191
Q

Treat poor responders

A

Relapses in patients whose schizophrenia was once under control but no longer respond

192
Q

Second generation antipsychotics for schizophrenia

A

Clozapine-agranulocytosis mainly bipolar

Risperidone-increased prolactin

Olanzapine-weight gain, diabetes

Quetiapine-weight gain, excessive sedation, less risk tardive

Ziprasidone-QT prolongation

193
Q

Behavioral therapy for schizophrenic and psychotic

A

Behavior management
-how get stuff that goes int he freezer into the freezer

Insite oriented is detrimental!!!! Not psychotherapy more agitated and disturbed

ECT-if better lack of diagnostic clartiy

194
Q

Delusional disorder

A

Delusions 1 motnh or longer

Not get criteria for schizophrenia

Functioning ok and not weird

Not from other things like substances

195
Q

Brief psychotic disorder

A

At least 1 day but less than 1 month duration of episodes

At least one of
Delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior

All day for 1 day at least

196
Q

If longer than 1 month

A

Not brief psychotic disorder

197
Q

Schizophreniform disorder

A

Two of these for sig time in 1 month at least 1 must be

Delusion
Hallucination
Disorganized speech
Grossly disorganized or catatonic behavior
Negative symptoms

At least 1 month but less than 6 months

198
Q

Schizoaffective

A

Uninterrupted period of illness which major mood episode with criterion A of schizophrenia

Major mood episode-can be depression or mania concurrent it’s it

Delusions or hallucinations for 2 or more weeks in absence of a major mood episode

199
Q

Major depressive

A

Severe what psychosis high risk suicide hospitalize them

When depression better psychosis is gone

200
Q

Substance/medication induced psychotic disorder

A

Delusions and hallucinations (one or both)

Criterion a develop during or soon after substance intoxication or withdrawal or after exposure to a med

Involved substance/med is capable of producing the symtpoms in criterion a

ABOUT 1 month or more suspect another disorder has been triggered by the drug and is now diagnosable not better explained by other things

201
Q

Catatonic disorder

202
Q

Persistent auditory hallucinations, delusions with significant overlapping mood episodes, attenuated psychosis syndrome, delusional symptoms in partner of individual with delusional disorder

A

Other specified schizophrenia spectrum

203
Q

Persistent auditory hallucinations

A

In absence of other features

204
Q

Delusions with significant overlapping mood episodes

A

Mood and delusion

205
Q

Attenuated psychosis syndrome

A

Psychotic like symptoms below threshold

206
Q

Delusional symptoms in partner of individual with delusional disorder

207
Q

What ear there

A

Other specified schizophrenia spectrum

208
Q

Schizoid

A

Very introverted and voluntarily withdraws from social interactions

209
Q

Schizotypal

A

Schizoid symptoms and magical thinking and odd behavior

210
Q

Schizophrenia

A

Schizotypal and psychosis

211
Q

Schizoaffective

A

Schizophrenia and mood disorder

212
Q

Schizophrenia and violence

A

Not more likely to kill ppl

If antisocial, borderline, paranoid, content of auditory hallucinations, substance abuse, impulsive, talking about violence, history of violence can be very dangerous

213
Q

Personality disorders

A

Inflexible and maladaptive

And everyone else in the family doesn’t act like this

Misperception world around them and react bad

214
Q

Diagnose personality disorder

A

Over 18

Stable

Enduring pattern not better accounted for as manifestation

Enduring pattern is not due to the direct physiological effects of substance or medical condition

215
Q

Who don’t diagnose with personality disorder

216
Q

A

A

Paranoid personality disorderL irrational suspicions and mistrust of others

Ppl exploiting or deceiving them

Distrust can get erratic and aggressive and agitated with ppl around them

217
Q

Cluster a schizoid

A

Lack of interest in in social

Don’t do much for fun

Few friends

218
Q

Schizotypal A

A

Odd behavior or thinking

Vague circumstantial speech

Social anxiety

Magical thinking

Don’t like being around ppl=like being along

219
Q

B

A

Bad dramatic, errratic

Antisocial personality disorder-

Borderline

Histrionic

Narcissistic

220
Q

Antisocial

A

Pervasive disregard for law and rights of others

No responsibly

Blame other ppl for their problems

No remorse

Men

Risk for anxiety disorders, substance abuse, somatization disorder, pathological gambling

221
Q

Borderline

A

Black white thinking, instability in relationships, self image identity and behavior

Frantic efforts to avoid expected abandonment
Unstable and intense interpersonal relationships
Unstable self image
Impulsive
Recurrent SUICIDALITY 
Cutting
Sex substance abuse
Self mutliating

Feel empty hate themselves and hate everyone else

Transient paranoia or dissociation

WOMEN
Male borderline-lethal

Super manipulative-immature personality traits. Teddy bear and tweety bird sign

Need to set rigid boundaries with these patients
Constant reminders of patient guidelines and responsibilities
Will often split staff members.providers against each other

Victims of sex abuse or emotional abuse
Have high rate of comorbidity major depression

222
Q

Histrionic

A

Pervasive attention seeking behavior including inappropriate sexual seductiveness and shallow or exaggerated emotions

NEED ATTENTION

Quite dramatic and sexual

Emotionally labeled

Vague and impressionistic speech highlighted

La belle indifference-indifferent detachment, while describing dramatic physical symtpoms

Somatotropin too

223
Q

Narcissistic

A

Pervasive pattern of grandiosity, need for admiration and lack of empathy

Exaggeration of talents and accomplishments
Sense entitlement
Exploitation o fathers
Surgeon
Enzy of others
Arrogant, haughty attitude

Anorexia nervous, substance abuse, depression

224
Q

Cluster c

A

Anxious or fearful

Avoidant personality disorder

Dependent
Obsessive compulsive

225
Q

Avoidant personality disorder

A

Social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation and avoidance

Not schizoid by desire relationships

Shy but not odd

Paralyzed by their fear nd sensitivity into social isolation

226
Q

Avoidant personality disorder

A

Can’t make decisions without guidance and reassurance

Seeking another relationship

Can’t initiate activities

227
Q

OCD

A

Preoccupied with perfectionism and control

Lack flexibility or openness

Preoccupations interfere with their efficiency despite their focus on tasks

Scrupulous and inflexible

Things have to be done my way

228
Q

Dissociative identity disorder

A

Two or more identities

Women and sexual abuse

229
Q

Treat psychodynamic psychotherapy

A

Examines way patient perceive events
Assumption that perceptions are shaped by early life
Identify perceptual distortions and their historical sources
Facilitate the development of more adaptive modes of perception and response

Frequency from several times a week to once a month; it makes use of transference

230
Q

Treat CBT

A

Deals with how ppl think about their world and their perception of it

Limited to episodes of 6-20 weeks, once weekly

231
Q

Group psychotherapy

A

Interpersonal psychopathology to display itself among peer patients

Usually once weekly over a course that Amy range from several months

232
Q

Dialectical behavior therapy-FOR BORdERLINE

A

Skills based therapy developed

Borderline
Stable sense of self

Reduce impulsive erratic self destrucive behavior

Manual based therapy is on the development of coping skills to improve affective stability and impulse control and on reducing self harmful behavior

233
Q

Borderline

A

I hate u don’t leave me

Sometimes I act crazy

234
Q

Meds

A

Not curative

235
Q

Why no MAOI

A

Don’t want overdose

236
Q

SSTU

A

Safe fir them

237
Q

Meds borderline

A

Less effective than in patients with uncomplicated major depression

238
Q

Valproic acid

239
Q

If try multiple meds and they don’t change

A

Personality disorder
They are poly pharmacy

Ask about suicide
Don’t get them no too much

240
Q

Complications personality disorder

A

Suicide
Substance
Injury
Depression

Hoomicide-paranoid esp

241
Q

Prognosis

A

A b better with age

C older worse

242
Q

Worst prognosis

A

B

Susceptible to problems of substance abuse impulse control and suicidal behavior ,which may shorten their lives

243
Q

Psychosomatic medicine

244
Q

Psychosomatic assumptions

A

Unit of mind and body
Psychological factors

Influenced complementary and alternative medicine as well as behavioral medicine

Holistic approach to medicine

245
Q

Stress theory

A

Circumstance that disturbs or is likely to disturb the normal physiological or psychological functioning of a person.

Stimulation of autonomic nervous system particularly the sympathetic nervous system

Tachycardia up CO

246
Q

SLE

A

Psychiatric symptoms

Supportive psychotherapy can help patients acquire knowledge and maturity to cope and promote positive interactions

Psychosis

247
Q

MS

A

Anxiety, euphoria, Mania

248
Q

Seizure disorder

A

Complex partial seizures cause sensory distortions, violence, belligerence

Confusion, psychosis, dissociative symptoms, catatonic like, bizarre nahavior

249
Q

CV

A

Type A, hostility anger, mental stress

Also depression, sudden cardiac death, HTN,

250
Q

Asthma

A

SOB anxiety disorder/panic disorder

251
Q

Thyroidhyper

A

Heat intolerance, excessive sweating, diarrhea, weight loss, tachycardia, palpitations, vomiting, fine tremor, hyperactivity, short attention span, impaired recent memory

Nervousness, excitability, irritability, irritability, pressured speech, insomnia, psychosis, visual hallucinations

252
Q

Hypo

A

Cole intolerance, dry skin, constipation, weight gain

Lethargy, depressed personality change, paranoia

253
Q

Diabetes

A

Depression!!!!!
Frustration, loneliness, dejection

Get thyroid panel

254
Q

Hyponatremia

A

Thirst, stupor, coma, seizures

Confusion, lethargy, personality changes

Geriatric!

255
Q

Thiamine defines

A

Poor concentration, confusion, confabulation.

Alcoholics

256
Q

Coral in b21

A

Pallor dizziness, peripheral neuropathy, dorsal column signs, ataxia

Irritability inattentativeness, psychosis, dementia

257
Q

PUD

A

Psychological stress

258
Q

UC

A

Dependent personality

259
Q

Crohn

A

Per existing panic disorder

260
Q

TCA

A

Anticholinergic effects

261
Q

SSRI

262
Q

Pancreatic carcinoma

A

Weight loss, abdominal pain, depression, lethargy, anhedonia, apathy, decreased energy

263
Q

Acute intermittent porphyria

A

An pain, fever, nausea, or minting, constipation

Acute depression, agitation, paranoia, Vidal hallucinations

264
Q

Hepatic encephalopathy

A

Asterisks, hyperreflexia, spider angioma, palmar erythema, ecchymosis, liver enlargement

Euphoria, disinhibition psychosis, depression

265
Q

Atopic dermatitis, psoriasis

A

Depression

266
Q

Frontal lobe tumor

A

Mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, losss of smell

267
Q

Occipital lobe tumor

A

Aural, visual hallucinations

Smell something burning

Olfactory

268
Q

TBI

A

Head trauma

Confusion, personality changes, memory impairment

269
Q

Treat

A

Self observation, cognitive restructuring, relaxation, mindfulness

270
Q

The study, practice, and teaching of the relation between medical and psychiatric disorders

A

So sultan ion liaison psychiatry

271
Q

Delirium

A

Hospital acquired confusion
Psychosis

This is temporary and reversible

272
Q

Delerium vs emdntia

A

Reversible and acute onset

Don’t know what hey are or where they are

273
Q

Who don’t get benzodiazepines

274
Q

How prevent delirium

A

Keep noise down at night
Avoid benzodiazepines
Cognitive stimulation

275
Q

PCP

A

Elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting

Agitation with blank state, anxiety, stupor aggression, panic, bizarre bahevior

276
Q

LSD

A

Sympathetic excess

Sensory distortion

277
Q

Corticosteroids

A

Mania, psychosis (hallucinations0

If COPD get IV steroids get delirious psychotic and manic

278
Q

Benzodiazepines

A

Sedation, paradoxical agitation

Avoid in elderly with delirium

279
Q

Anti Parkinson’s

A

Psychotic symptoms, mania, anxiety

CBT cause dopamine release

280
Q

Antidepressants

A

Mania anxiety, insomnia

281
Q

COPD gets treatment what cause symptoms

A

IV steroids

282
Q

Diabetes nausea and vomiting and depression how treat

A

Sertraline

-

283
Q

Lithium

284
Q

Lorazepam

285
Q

Olanzapine

A

Schizophrenia and bipolar

286
Q

Bupropion

A

Nicotine withdrawal

287
Q

Imipramine

288
Q

Duloxetine

A

Diabetic peripheral neuropathy, fibromyalgia, and chronic musculoskeletal pain

289
Q

Duloxetine

A

Stress incontinenee

290
Q

General antidepressants MOA

A

Block serotonin and be re uptake by sert, net, or both

291
Q

Ssri

A

Citalopram, escitalopram, fluoxetine, paroxetine, sertraline, fluvoxamine

292
Q

Snri

A

Duloxetine, milnacipran, venlafaxine

293
Q

Tca

A

Amitriptyline, clomipramine, imipramine

294
Q

5ht modulators

A

Nefazodone, trazodone, vortioxetine

295
Q

Atypical

A

Amoxapine, bupropion, mirtazapine, vilazodone, maprotiline

296
Q

Maoi

A

Phenalzine, selegiline

297
Q

SSRI for ocd/sad

A

Fluvoxamine

298
Q

Snri (and TCA)

A

Selectively inhibit the presynaptoc reputable of serotonin via sert and ne via net

299
Q

Tertiary amine tca

A

Inhibit ne/serotonin equally

300
Q

2 amines TCA

A

Inhibit NE>serotonin

301
Q

3 tca

A

Amitryptline, clomipramine, doxepin, imipramine

302
Q

Secondary amines

A

Amoxapine, desipramine, nortriptyline

303
Q

Snri

A

All tca

Desvenlafaxine, duloxetine, venlafaine, levomilnacipran

304
Q

Snri and da

305
Q

TCA always block other receptors

306
Q

TCA-based SNRA impact 3 key non efficacy related receptors

A

Histamine, muscarinic, a1

307
Q

Amitriptyline indication

A

Relied of symptoms of depression

308
Q

Contraindications amitriptyline

A

Hypersensitivity, MOAI (hypertensive crisis, convulsion and death)

309
Q

Black box warning amitriptyline

310
Q

Interactions amitriptyline

A

P450 2d6 drug metabolizes

311
Q

Tri cyclic agents toxic

A

Coma, cardio toxicity, convulsions

312
Q

Cardiovascular tca ae

A

Tachycardia, orthostatic hypotension, dysrhythmias

313
Q

Anticholinergic

A

Dry. Mouth, urinary retention/constipation

Blurred vision

314
Q

CNS TCA system ae

A

Sedation/fatigue. Dizziness/seizures

315
Q

Amitryptiline

A

Seizures, sedation, cardiac

316
Q

Clomipramine

A

Seizures*, sedation , cardiac

317
Q

Doxepin

A

Seizures, sedation, cardiac

318
Q

Imipramine

A

Seizures, sedation, cardiac

319
Q

Trimipramine

A

Seizures, sedation, cardiac effects

320
Q

Amoxapine indications

A

Depression with neurotic or reactive depressive disorders and endogenous and psychotic depression.

Depression with anxiety and agitation

321
Q

Onset amoxapine

A

Rapid. Four to seven days get effect

322
Q

Contraindications

A

Hypersensitivity, MOAI, hyperpyretic crises, convulsions, deaths if MOAI and TCA together

323
Q

Warning amoxapine

A

Suicide risk in MDD, worse depression suicide

324
Q

Use amoxapine with caution

A

Urinary retention, angle closure glaucoma, increased intraocular pressure. CVD TCA can cause sinus tachycardia, Arrhythmias

325
Q

Amoxapine, despiramine, maprotiline, nortriptyline, protriptyline

A

No GI, sex, cardiac

326
Q

Indications SSRI-escitalopram

327
Q

Warning BBW escitalopram

A

Suicide with MDD< worse depression,

328
Q

Discontinuation SSRI

329
Q

MAOI and SSRI

A

Fatal reactions can occur with hyperthermia, rigidity, myoclonus, autonomic instability, fluctuations of vital signs and mental status

330
Q

SSRI MOA

A

SERT inhibit reputable of serotonin

331
Q

SSRI

A 
Citalopram
Escitalopram
Fluoxetine
Paroxetine
Sertraline
Vilazodonevortioxetine
332
Q

SSRI and other receptors

A

Less impact on histamine, muscarinic and Adrenergic receptors, fewer side effects than TCA

333
Q

Ae SSRI

A

CNS, sexual dysfunction, weight gain, acute withdrawal reactions, flu like symptom

334
Q

Rare AE ssri

A

QT prolongation, hyponatremia, serotonin syndrome, sweating, hyperreflexia, aka this is/myoclonus, shivering

SUICIDALITY-kids young adults

335
Q

Opioid and antidepressants

A

CNS reactions alled serotonin syndrome

336
Q

Drug drug SSSRI

A

Cyp450

Most is fluoxetine (strong inhibitor)

Least is citalopram and sertraline (mild inhibitors)

337
Q

Citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, venlafaxine

A

GI, sexual

338
Q

Ae atomoxetine

339
Q

Mirtazapine, nefazodone, trazodone

340
Q

Phenelzine MAOI

341
Q

Tranylcypromine

342
Q

Selegiline MAOI

343
Q

5 Rs’ of antidepressant efficiency

A

Response >50% reduction ins ymptoms from baseline -partial response>25% reduction but <50% reduction in symptoms from baseline

Remission-symptoms free

Recovery-2-6 months of ongoing remission but before recovery

Recurrence-return of symtpoms after recovery

344
Q

General antidepressant efficacy

A

Work after 3-8 weeks

Goal is remission/recovery

Minority reach remission with a single agent

345
Q

What do if don’t respond to one after 8 weeks

A

Switch to a different MOA

If partial response aff another agent

346
Q

Mono therapy

A

For unipolar, not depressive phase of bipolar

347
Q

How get off antidepressants

A

Slow titration downward is recommended

348
Q

Mood stabilizers

A

Lithium

Carbamazepine, lamotrigine, divalproate/valproic acid

349
Q

Mood stabilizers

A

All except lithium were originally approved as anti seizure medications

350
Q

Lithium MOA

A

Inhibits calcium dependent and depolarization provoked release of NE and DA

Inhibits receptor blockers and substances known to stimulate and inhibit G protein synthesis/actions

Interfere with inhibitory G protein and stimulators to keep inactive

351
Q

A lithium

A

Nephrogenic diabetes insipidus

Polyuria polydypsia

352
Q

Lithium and diuretics

A

Preferential na loss and li reabsorption

ESP thiazides

353
Q

Acei and lithium

A

Linisopril

354
Q

NSAIDs and lithium

A

Alter renal perfusion

355
Q

Narrow therapeutic agent

356
Q

Lithium indications

A

Acute maintenance treatment of mania/bipolar I disorder

Augmentation in unipolar depressive patients with inadequate response to antidepressant therapy

357
Q

Off label lithium

A

Reduced risk suicide and all cause mortality in patients with mood disorders

358
Q

3 anti seizure mood stabilizers

A

Carbamazepine
Valproic acid/divalproex
Lamotrigine

359
Q

Uses indications mood stabilizers anti seizure

A

Divalproex for acute bipolar I without psychotic features 50-125 mcg/ml

Carbamazepine for acute maintenance treatment of acute mania an dmxed episodes (bipolar I)

Lamotrigine for maintenance of bipolar I and II

360
Q

Carbamazepine is what

A

Major cyp450 inducer

361
Q

HYPOPHOSPHATEMIA in alcoholic patient from decreased absorption

A

Due to poor dietary intake of both phosphate and vitamin D

Due to binding of dietary phosphate by antacids given to treat recurring gastritis (calcium carbonate)
Reduced net intestinal phosphate absorption, which may be induced by chronic diarrhea

362
Q

Increased urinary phosphate in alcoholic with hypophosphatemia

A

Hypereparathyroidism induced by vitamin D defiency

363
Q

Alcohol and hypophosphatemia

A

Get vitamin D levels

Can cause proximal tubule dysfunction so don’t get reabsorption

364
Q

Look for hypophosphatemia when who comes in

A

Alcoholic eating disorder or get severe damage

365
Q

Dextrose containing solution in alchohol

A

Stimulate insulin promote phosphate uptake into cells

Get acute respiratory alkalosis from alcohol withdrawal which stimulated I traced intracellularl phosphofructokinase andicnreases glycolysis and movement of phosphate into cells

366
Q

What is low phosphate

367
Q

What do when alcoholic patient admitted to hospital

A

PHOSPHATE monitoring

368
Q

Treat hypophosphatemia

A

Not necessarily symptomatic I f less than 2mg/dL

369
Q

What happens if hypophosphatemia alcoholic

A

Myopathy due to both phosphate depletion and alcohol toxicity, and are at risk for clinically significant rehab do Yoshi’s

370
Q

Acute alcoholic myopathy

A

CK

Alcohol can cause muscle damage

Starvation decreases alcohol metabolism and results in increased blood alcohol levels

371
Q

Thiamine defiency related encephalopathy

A

Thiamine defiency
We Ricky is acute syndrome require int emergent treatment o prevent death and neurological morbidity

Korsakoff-chronic neurological condition that usually occurs as a consequence of WE

372
Q

Thiamine

A

Cofactors for enzymes in energy metabolism

Transketolase
Alpha ketoglutarate DH
Pyruvate DH

Thiamine requirements depend on metabolic rate with the greatest need during periods of high metabolic demand and high glucose intake

This manifest by the precipitation of wet icky encephalopathy

373
Q

Add glucose

A

Stimulate pathway and whole body use thiamine and use up faster than and cells dependent on glycolysis are going to be deprived

374
Q

Triad of wear ice

A

Encephalopathy, oculomotor dysfunction-nystagmus, gait ataxia

375
Q

Commonly affected areas of thiamine defiency

A

Third ventricle, aqueduct, fourth ventricle, mammillary Brodie, cerebellum

Global

376
Q

Enlarged ventricles

377
Q

Less frequently effected areas wernicke k

A

Hippocampus-medial temporal lobe

378
Q

Lab wernicke

A

No lab study

Thiamine blood level not accurate by don’t know how much reservoir-liver and can release cant measure reservoir

379
Q

Treat WE

A

Immediate parent earl thiamine

Glucose without thiamine worse

Thiamine before glucose

380
Q

Prevent WE

A

Don’t give glucose loading with unsuspected thiamine defiency

Give thiamine before

381
Q

Take home medical emergency

A

Thiamine initiated immediately

382
Q

We

A

Anterograde and retrograde

Medial temporal lobes

Alcohol abusers

KS may result from a. Series of sub clinical or unrecognized episodes of WE

383
Q

Extrapyrminla syndrome from anti[sychotic drugs

A

Acute dystopia reactions

Drug induced parksonism

Akasithisa

Antipsychotic induced catatonic

Tardive dyskinesia

384
Q

Tardive dyskinesia

A

Fasciculations of the tongue , lingual facial hyperkinesis, choreathetotic movements of the extremities and trunk

385
Q

Acute systolic reactions

A

Sudden tonic contractions fo muscles of tongue, neck, back, mouth, eyes

386
Q

Dru induced Parkinsonism

A

Cogwheel rigidity, bradykinesia, tremor, loss of postural reflexes, mask like fancies

387
Q

Akasthisia

A

Motor restless, may involve the entire body

388
Q

Antipsychotic induced catatonic

A

Withdrawal mutism motor abnormalities

389
Q

Tardive dyskinesia

A

Fasciculations fo the tongue, lingual facial hyperkinesis, choreathetotic movements of the extremities and trunk

390
Q

Neuroleptic malignant syndrome

A

Muscular rigidity, fever, autonomic instability, altered level of consciousness

391
Q

Tardive dyskinesia

A

Medication induced hyperkinetic movement disorder goes for a month after discontinuation

Involuntary movements of patients face, mouth, trunk common

Chores, at hero’s is, stereotyped behavior, dystopia, akathisia, tics, respiratory dyskinesia, tremor

392
Q

AIMS

A

Abnormal involuntary movement scale for tardive dyskinesia

393
Q

When else see tardive dyskinesia

A

Withdrawal emergent
-children <1 month following discontinuation antipsychotic drug
Withdrawal dyskinesia TD
-dyskinesia in adults that occurs immediately after discontinuing or reducing the dose of a dopamine receptor blocking agent

Masked TD
-tardive movements that resolve when a dopamine receptor blocking agent is resumed or its dose is increased

394
Q

All dopamine receptor blocking agents

A

Can cause TD

395
Q

Anything block dopamine can cause TD

A

Antidepression No cause it

First second gen antipsychotics, metoclopramide, prochlorperazine, chlorpromazine

396
Q

Do antidepressants cause TD

397
Q

Who get TD

A

Ppl who get EPS early on

398
Q

Dopamine hypothesis

399
Q

5 ht2a hypothesis

A

Polymorphism in 5HT2a receptor gene have been linked to susceptibility to TD

400
Q

Clozapine

A

Serotonin antagonist with strong binding to 5HT2a/2c receptor

Lower incidence TD
Favorable effect on TD

401
Q

GABA hypothesis

A

Chronic treatment with antipsychotic drugs get persistent dyskinesia and gaba metab

402
Q

Treat TD

A

Stop drug
Switch 1st to 2nd generation

Use benzodiazepines, Botox, valbenazine, or tertrabenazine

403
Q

Ginkgo balboa extract

A

Treat TD egb-761

404
Q

Anticholinergic drugs for TD

A

Benztropine

Ineffective or may exacerbate

Sometimes helpful for ameliorating Tardive dystonia but tardive dyskinesia worse

So know diffference between dystonia and dyskinesia

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