High Yield: Psy 1 Flashcards
Describe management: Neuroleptic malignant syndrome (2)
- Discontinue antipsychotic
- THEN administer Dantrolene
What’s the difference between:
- Neuroleptic malignant syndrome
- Seretonin syndrome
- Neuroleptic malignant syndrome: no myoclonus
- Seretonin syndrome: myoclonus
Name antidotes: Seretonin syndrome (2)
Discontinue
- Benzos
- Cyproheptadine
What type of antidepressants predisposes to tyramine crisis? (1)
- MAOI (ex: phenelzine, isocarboxazid)
Tx: Tyramine crisis? (3)
Tx: Hypertensive Emergency drugs
- Nitroprusside
- Hydralazine
- Labetalol
Name extrapyramidal sx of antipsychotics (4)
- Dystonia
- Akathisia
- Parkinsonism
- Tardive dyskonesia
Describe: Dystonia in EPS (3)
- early, within hours
- usually affects sternocleidomastoid (torticolis) -> neck turned and contracts
- tx: benztropine or benadryl
Describe: Akathisia in EPS (3)
- restless, keep moving, can’t sit still
- tx: benzos or beta blockers
Describe tx: Parkinsonism in EPS (1)
- Benztropine (due to antipsychotic drug side effect)
Describe: Tardive dyskenisa in EPS (3)
- lip smacking
- tx: discontinue
- valbendazine (new)
- switch to clozapine (least risk of causing it)
Describe: Clozapine (2)
- agranulocytosis
- (low granulocytes, low basophils/eosinophils/neutrophils)
- periodic CBC
- if infx, discontinue clozapine
- decreases suicide risk the most
Name mood stabilizer that lowers suicide risk
Lithium
Describe management: Lithium toxicity (2)
- Hydrate
- Hemodyalisis
Name indications: Dialysis indications
AEIOU
- Acidosis
- Electrolytes (K+)
- Intoxicants (MALE)
- Methanol, Aspirin, Lithium, Ethylene glycol
- Overload
- Uremia
Describe management: TCA toxicity (1)
- Sodium bicarbonate (flushing out TCA)
Describe management: Cocaine overdose (1)
- benzo (IV lorazapam + observe)
Describe management: Alcohol withdrawal (1)
IV benzos
Describe management: Delirium tremens (1)
- Benzos
Describe the difference between alcoholic hallucinosis and delirium tremens
Look for timing and vitals
- Alcoholic hallucinosis: vitals stable, within 6-12h
- Delirium tremens: unstable (hypertensive, tachycardia), 2-4 days after stopping
Describe: Phencyclidine (PCP) overdose (4)
- violent
- psychotic
- nystagmus
- blood test: elevated CPK
Describe tx: Phencyclidine (PCP) overdose (1)
- tx: benzo
What to think of with elevated CPK (2)
- PCP
- neuroleptic malignant syndrome
Describe management: Benzo overdose (1)
- Flumazenil (only in non-dependent user of benzo, if not can get life-threatening withdrawal)
Describe management: Chronic Benzo withdrawal (1)
- tx = benzo taper
Describe management: Opioid overdose (1)
Naloxone
Describe management: Opioid withdrawal (1)
Supportive
clonidine
Name 4 pathways of antipsychotics
- Mesolimbic: positive sx
- Mesocortical: negative sx
- Nigrostriatal: parkinson sx
- Tuberoinfundibular: dopamine prolactin pathway (dopamin suppresses prolactin release) -> hyperprolactinima, gynecomastia
Name antipsychotic famous for hyperprolactimia
Risperidone
Name factors for bad prognosis for schizo (3)
- Early onset
- Male
- Slow onset
(best prognosis: female, sudden, late onset)
Describe 1st generation antipsychotic (4)
- High Potency = Haloperidol, Fluphenazine
- More frequent: EPS
- Low Potency = HAM Block
- antiHistamine: Drowsiness. Dry mouth, dry eyes. Blurred or double vision. Dizziness and headache. Low blood pressure.
- Alpha 1 blockade: HTO, dizziness, headache, tachycardia, nasal stuffiness
- antiMuscarinic: dry mouth, constipation, blurred vision, drowsiness, no/vo, abdominal discomfort, difficulty micturating, palpitations, skin reactions.
Name 2nd generation antipsychotic (4)
- risperidone
- olanzapine
- aripiprazole
- ziprazadone
Describe 2nd generation antipsychotic (2)
- ex: clozapine, risperidone, olanzapine, aripiprazole, ziprazadone
- side effects: metabolic syndrome (hyperlipidemia, hyperglycemia, obecity)
- check BMI, blood pressure, glucose, lipids
- most common: olanzapine (trick: O for obesity)
Name adverse effect of thioridazine (1st gen)
Retinal pigmentation
Name adverse effect of chlorpromazine
Corneal deposits
(chlo > corneal)
Describe: Schizoaffective disorder (2)
- Baseline schizo + (depressive or manic episodes)
- tx: 2nd gen antipsychotics or mood stabilizer (lithium)
What’s the timeline for:
- brief psychotic disorder
- schizophreniform
- schizophrenia
- brief psychotic disorder:
- schizophreniform: 1-6 months
- schizophrenia: > 6 months
Describe sx: Bipolar Disorder (7)
3+ DIGFAST
- Distracted
- Insomnia
- Grandiosity
- Flight of ideas
- Activity
- Pressured Speech
- Thoughtlessness
What’s the difference mania and hypomania (3)
- Mania Type 1
- Requires hospitalisation
- At least 3 sx of DIGFAST for ONE WEEK + social dysfunction
- Hypomania Type 2
- At least 3 sx of DIGFAST for FOUR DAYS + no social dysfunction
Name effects: Tricyclic antidepressants (4)
- HAM block
- Tri Cs:
- Cardiac: Long QT, arythmia
- Convulsions
- Coma
Describe: Serotonin syndrome (2)
- Look for someone that was started with SSRI, discontinued and started another too quickly in another class
- When you stop SSRI, it takes a few week before washing out all serotonin
How long does antidepressant takes to start working
4-6 wks
Describe: Electroconvulsive Therapy (ECT) (3)
- For emergencies, need rapid chances
- Classic scenarios:
- refusal eat or drink
- high suicide risk
- Side effect: Amnesia for 6 months that will resolve
Describe tx of catatonia 2e to antipsychotics
Lorazepam
Describe the difference between grieving and depression (2)
- Grieving: good and bad days
- normal to have guilt, wished they died instead, see the dead person
- Depression: more bad days
- feelings worthlessness
Describe 2ed effects of lithium (5)
LMNOP
- lithium
- movement problems
- nephrogenic diabetes insipidus
- hypOt4
- pregnant defects (Ebstein’s anomaly: your tricuspid valve is in the wrong position and the valve’s flaps (leaflets) are malformed)
How long for persistent depressive disorder?
2 years
Describe: Cyclothymic disorder (3)
- not quite bipolar
- mild, not exactly hypomania or depression
- 2 years
Describe: Premenstrual dysphoric disorder (2)
- keep menstrual diary
- first-line tx: SSRI
Describe tx: Acute panic attack
- Acute: Benzo
- Panic disorder: SSRI (4-6 wks to work)
What’s the difference between acute panic attack and pheochromocytoma?
pheo: high TA
What’s the tx: Public speaking phobia (2)
- BBloquer (not benzo, bc sedating)
- Only give benzo if asthma + public speaking phobia
What’s the difference: Social anxiety disorder vs avoidant personality disorder (2)
- Social anxiety disorder: fear of embaresement public
- Avoidant personality disorder: fear of rejection, but want to make friends but don’t know what
tx: CBT
What’s 1st line tx: OCD
- Exposure response control
What’s the therapy of borderline personality disorder?
Dialectical Behavioral Therapy
What’s tx of adjustment disorder (1)
supportive
