First Aid: Psychiatry Flashcards
Mixed Episode Criteria
Meet criteria for mania and MDD everyday for a week.
Mania vs. Hypomania (duration)
Mania lasts 7 days; Hypomania lasts 3 days.
Mania vs. Hypomania (psychotic features, hospitalization)
If a patient has psychotic features or is hospitalized, by definition, the person is manic.
Sleep problems in MDD
Multiple awakenings, initial and terminal insomnia, hypersomnia, REM is shifted to early in the night, and stage 3 and 4 sleep decrease.
Results of Dexamathasone Test in MDD
Increased cortisol levels.
Atypical Depression Features
Hypersomnia, hyperphagia, reactive mood, leaden paralysis, hypersensitivity to rejection.
Bereavement
Lasts 2 months or less and is characterized by crying spells, trouble sleeping/concentrating, illusions and mild cognitive disorder for less than 1 year. There is no disorganization or suicidality.
What is the probability of developing Bipolar Disorder if one of your parents has it?
10%
Best treatment for Bipolar Disorder for mood stabilization in rapid cycling or mixed patients and manic episodes?
For euthymia in rapid cycling or mixed patients, treat with valproic acid/carbamazepine. For manic patients, prescribe olanzipine, quetiapine, or ziprasadone.
Bipolar II Disorder
1+ MDE and 1+ hypomanic episodes.
Dysthymic Disorder
2 years of depression with 2 listed criteria and never asymptomatic for more than 2 months. Patient has never been manic or hypomanic (otherwise, the diagnosis would be bipolar disorder).
Cyclothymic Disorder
Alternating periods of hypomania and periods of mild depression for at least 2 years and never symptom free for greater than 2 months.
Adjustment Disorder
Symptoms develop within 3 months of a triggering event and end within 6 months. The stressor is not life-threatening (as opposed to PTSD).
Panic Disorder
No obvious precipitant of a panic attack which consists of palpitations, nausea, fear of death, choking or sweating. One of the attacks must have been followed by a minimum of 1 month of concern about additional attacks or significant change in behavior related to attacks. Disorder can be with or without agoraphobia.
Specific Phobia
Irrational fear of an object or situation. Exposure results in immediate anxiety and the patient realizes it’s excessive. If the patient is under 16 y.o., the fear must be present for more than 6 months for diagnosis.
Treatment for Specific Phobia
Systemic Desensitization (gradual exposure) or Flooding (confront patient with full fear). Pharmacology is generally ineffective, but you can provide benzos/beta-blockers.
Social Phobia Treatment
Provide CBT as a treatment as well as an SSRI and beta-blockers.
Treatment for OCD
SSRIs, TCAs, Exposure and Response Therapy (ERP)
PTSD
Response to catastrophic experiences characterized by re-experiences, numbing/hyperarousal and persistent avoidance for 1+ month. Treatment is SSRIs, TCAs, MAOis, anticonvulsants (for nightmares), CBT and Eye Movement Desensitization and Reprocessing (EMDR). Avoid benzos.
Acute Stress Disorder
Same criteria as PTSD. Catastrophic life event that occur less than 1 month ago and symptoms have lasted for less than 1 month.
Generalized Anxiety Disorder
Excessive hyperarousal about daily events for 6 months or more. Treatment is SNRIs, buspirone, benzos and CBT.
Relation of Cluster A Personality Disorders to Schizophrenia
Paranoid - Increased incidence with family history of schizophrenia; Schizoid - No increased incidence with family history of schizophrenia; Schizotypal - Premorbid for schizophrenia.
Antisocial Personality Disorder Criteria
Patients must be 18 y.o. and have a history that is consistent with Conduct Disorder. Treatment with psychotherapy is not indicated, CBT or DBT is preferred.
Avoidant Persondality Disorder
Avoid interpersonal occupation due to fear of rejection/critique. Believes he or she is socially inept/inferior. Different from Social Phobia in that Avoidants are fearful of being rejected, whereas Social Phobics are fearful of being embarrassed.
Treatment for Personality Disorders
Most often, it is psychotherapy, except for Borderline Personality Disorder and Antisocial Personality Disorder.
Alcohol Mechanism
Activates GABA (inhibitory) and inhibits glutamate (activating).
Metabolism of alcohol
EtOH»Acetaldehyde (by alcohol dehydrogenase)»Acetic Acid (by aldehyde dehydrogenase).
Disulfram
Blocks aldehyde dehydrogenase in liver and causes aversive reaction to alcohol.
Naltrexone
Opioid receptor blocker; In patients with opioid dependence, it will precipitate withdrawal.
Acamprosate
Should be started post-detox for alcohol relapse prevention. Contraindicated in ESRD patients but acceptable in liver-diseased patients.
Topiramate
Anticonvulsant that potentiates GABA and inhibits glutamate receptors and decreases alcohol craving.
Wernicke’s Encephalopathy
Caused by thiamine deficiency and presents as a triad of: ataxia, confusion and ocular abnormalities (nystagmus, gaze palsies)
Korsakoff Encephalopathy
Chronic amnestic syndrome of impaired recent memory, anterograde amnesia, compensatory confabulation.
Cocaine Intoxication
Blocks DA reuptake from synapse. Causes euphoria, BP changes, HR changes, nausea, dilated pupils, weight loss, agitation/depression, chills, sweating. Danger: decreased respiratory rate, seizures, arrhthymias, paranoia, hallucinations (tactile). Deadly: vasoconstrictive effect (MI/stroke).
Cocaine Withdrawal
Post-Intoxication Depression: malaise, fatigue, hypersomnolence, depression, hunger, constricted pupils, vivid dreams, agitation/retardation.
Amphetamine Mechanism
Block reuptake/increase release of DA/NE.
Designer Amphetamines
MDMA, MDEA - Work by increasing release of DA/NE/5HT.
Amphetamine Intoxication
Dilated pupils, increased libido, perspiration, respiratory depression, chest pain. Overdose: hyperthermia, dehydration, rhabdomyolysis (renal failure).
PCP mechanism
Antagonizes NMDA glutamate receptors and activates DA neurons.
PCP Intoxication
Agitation, depersonalization, hallucination (tactile, visual), synesthesia, decreased judgement, decreased memory, assaultiveness, nystagmus (rotational, horizontal, vertical), ataxia, dysarthria, hypertension, tachycardia, muscle rigidity
Benzo Mechanism
Potentiate GABA by increase frequency of Cl- channel opening.
Barb Mechanism
Potentiate GABA by increase duration of Cl- channel opening.
Sedative Intoxication
Drowsiness, confusion, hypotension, slurred speech, incoordination, ataxia, mood lability, impaired judgement, nystagmus, respiratory depression, coma.
Benzo Overdose Treatment
Flumazenil
Sedative Withdrawal Treatment
Treat with a benzo taper; You can add on carbamazepine or valproic acid.
Opioid Intoxication
Sedation, N/V, constipation, slurred speech, constricted pupils, seizures, respiratory depression, coma/death.
Serotonin Syndrome
Hyperthermia, confusion, hyper/hypotension, muscle rigidity.
Opioid Overdose
Treat with naloxone or naltrexone (opioid antagonists), but may cause withdrawal in opioid-dependent patient.
Opioid Withdrawal
Symptoms include anxiety, insomnia, anorexia, fever, rhinorrhea, piloerection, dysphoria, insomnia, lacrimation, yawning, weakness, sweating, N/V, dilated pupils, abdominal cramps, arthralgia, myalgia, hypertension, tachycardia.
Treatment for Opioid Withdrawal
Clonidine, Methadone, Buprenorphine, Naltrexone.
Hallucinogens
Effects: illusions, hallucinations, synesthesia, labile affect, dilated pupils, tachycardia, hypertension, hyperthermia, tremors, incoordination, sweating, palpitaions.
Marijuana Intoxication
Euphoria, anxiety, impaired motor coordination, perceptual disturbances, mild tachycardia, conjunctival injection, dry mouth, increased appetite.
Inhalant Effects
CNS depressant that cause perceptual disturbances, psychosis, lethargy, dizziness, N/V, headaches, nystagmus, tremor, muscle weakness, hyporeflexia, ataxia, slurred speech, euphoria, hypoxia, stupor, coma. May be fatal secondary to respiratory depression or cardiac arrhthymias.
Caffeine Mechanism
Adenosine antagonist that increased the cAMP levels. It is also a stimulant via the DA system.
Alzheimer Disease
Decrease in ACh (due to loss of noradrenergic neurons in basal ceruleus) and decrease in choline acetyltransferase. Genes: presenelin I/II (amyloid precursor), APOe4. Amyloid Cascade Hypothesis: excess AB peptides. Post-mortem: diffuse atrophy with enlarged ventricles and flattened sulci as well as senile plaques and neurofibrillary tangles.
Alzheimer Disease Treatment
Cholinesterase Inhibitors, NMDA antagonists.
Vascular Dementia
Risk Factors: stroke, DM, hypertension, APOe4. Stepwise loss of function with spasticity, hemiparesis, ataxia, psuedobulbar palsy, lability, abnormal speech, dysphagia.,
Lewy Body Dementia
Caused by Lewy bodies and alpha-synuclein in basal ganglia. Waxing and waning cognition with hallucination and paranoia. Parkinsonism: tremor, bradykinesia, rigidity, shuffling gait, masked face, stopped posture, retropulsion. REM disorder common. Sensitive to neuroleptics. Diagnosis is made by timecourse: onset of dementia is within 12 months of Parkinsonism symptoms. If it’s greater than 12 months, then it’s Parkinson’s. Treatment includes cholinesterase inhibitors, levodopa/carbidopa, DA agonists, clonazepam.
Pick Disease/Frontotemporal Dementia
Between 45-65 y.o., 30% familial and associated with the MAPT gene. Characterized by disinhibition, echolalia, overeating, oral exploration of inanimate objects. Marked atrophy of frontal and temporal lobes, neuronal loss, astrocytic gliosis and microvacuolization.
Huntington’s Disease
Autosomal dominant with expanded repeat of CAG with an onset of 35-50 y.o. Dementia begins 1 year before or 1 year after chorea. Patients are aware of decreased cognition. Muscular hypertonicity, depression, psychosis. On MRI, there is caudate/cortical atrophy.
Parkinson’s Disease
Neuronal loss in substantia nigra (provides DA to basal ganglia). Parkinsonism: bradykinesia, cogwheel rigidity, resting tremor, masked face, shuffling gait, dysarthria. Similar to AD with senile plaques and neurofibrillary tangles and decreased acetyltransferase.
Creutzfeldt-Jacob Disease
Accumulation of prions in CNS. Rapidly progressive (6-12 months) and >90% have myoclonus. Basal ganglia and cerebellar dysfunction common. Diagnosis: spongiform changes of brain. Myoclonus, muscle atrophy, cortical blindness, mutism, ataxia, EPS, pyramidal signs.
Normal Pressure Hydrocephalus
Enlarged ventricles with increased CSF pressure. Triad of gait disturbance (apraxia), urinary incontinence, dementia. Treat by relieving pressure with shunt.
Psuedodementia
Apparent cognitive deficits secondary to depression. Those with dementia will confabulate. Those with psuedodementia with say “I don’t know”.
