miscellaneous Flashcards
side effects of lithium
- nephrogenic diabetes insipidus (can be used to counter effects of SIADH)
- Hypothyroidism
- Papillary thyroid carcinom
- Tremor, ataxia
- heart block
- arrhythmias
Can you take lithium in pregnancy?
no- contraindicated
if taken in 1st trimester= Ebsteins anomaly (atrialization of the right ventricle)
- mood disorder involving persistently depressed mood, with low self-esteem, withdrawal, pessimism, or despair
- present for at least 2 years
- no absence of symptoms for more than 2 months
Persistent depressive disorder (dysthymia)
A mood disorder- 2+ weeks of significantly depressed moods, feelings of worthlessness, and diminished interest or pleasure in most activities.
Major depressive disorder
What sxs should be present to diagnose major depressive disorder
5 or more SIEGECAPS for > 2wks nearly every day, at least one of the sxs is depressed mood or anhedonia:
- Sadness
- Interest/anhedonia
- Guilt
- Energy
- Concentration
- Appetite
- Psychomotor activity
- Suicidal
A pattern of negativistic, hostile, and defiant behavior
child often loses his temper, a_rgues with adults_, and often actively defies or refuses to comply with adults’ requests or rules.
Oppositional defiant disorder
Oppositional defiant disorder is a precursor to what? and then what?
oppositional defiant disorder –> conduct disorder–> antisocial personality disorder
14 y/o with aggression to people and animals
(often a bully or cruel to animals)
conduct disorder
14y/o (or less than 18) who has done the following:
- stolen
- rape
- destruction of property
*
conduct disorder
Tx for conduct disorder
integrate individual, school and family settings
address familial conflicts
Child with at least 4 sxs for >6mo:
- Frequent temper tantrums
- Arguments w/ adults
- intentional exasperation of others
- revenge seeking
- angry attituted
- etc
- NOT AGGRESSIVE TOWARDS PEOPLE OR ANIMALS, don’t destroy property, no theft or deceit
Oppositional defiant disorder
Tx for oppositional defiant disorder
- psychotherapy
- CBT and family therapy
- Pharmacotherapy
- mood stabilizers
- antipsychotics
- stimulants
______ is one of the most heritable psychiatric disorders
ADHD
Risk factors for PTSD (5)
- Female
- low socioeconomic status
- previous trauma
- Personal and family psych history
- separated/divorced/widowed
What is the post traumatic stress disorder checklist (PCL-5) used for?
20-item self-report measure used to:
- screen patients
- Monitor symptom severity over time
Difference between PTSD and acute stress disorder
- acute stress disorder- similar to PTSD but sxs < 1mo
- PTSD- sxs > 1mo
Pathogenesis- Risk factors for developing panic disorder
- Genetic
- Temperament, neurobiology, childhood trauma and stressful life experiences
- anxious personality traits
- neurotic personality trait
- Childhood exposure to sex/physical abuse
- childhood smoking
What 3 things are often stressors for panic disorder
life stressors
- loss
- threat to life
- Illness
which 2 personality traits put you at increased risk of developing panic disorder
neurotic personality trait
anxious personality trait
What is the hallmark and predominant cause of refeeding syndrome (seen in anorexia nervosa)
hypophosphatemia
About half of children w/ oppositional defiant disorder also have ________
ADHD
What is the MOA of THC?
partial agonist of cannabinoid 1 and cannabinoid 2 receptors
What is exhibitionistic disorder?
paraphilic disorder characterized by sexual arousal from exposure of ones genitals to an unsuspecting person
What is Frotteuristic disorder
paraphilic disorder- sexual arousal from touching or rubbing against a nonconsenting person
Sexual masochism disorder
sexual arousal from being humiliated, bound, beaten or tortured
What is Voyeuristic disorder
paraphilic disorder associated w/ sexual arousal from observing an unsuspecting disrobing or nude individual
What are some good prognostic factors (4) in a patient w/ exhibitionistic disorder
- only 1 paraphilia diagnosis
- self-referral for tx
- sense of guilt a/w the behavior
- H/o otherwise normal sexual activity occuring in addition to the paraphilia
Which personality disorders make up cluster C
- Avoidant
- Dependent
- Obsessive-compulsive personality disorder
What hematologic abnormality caused by nitrite abuse may require IV methylene blue administration
methemoglobinemia
How many symptoms for mild, moderate vs severe alcohol use disorder
mild: 2-3 sxs
moderate: 4-5sxs
severe: 6+ sxs
First line pharmacotherapy in moderate- severe alcohol use disorder
oral naltrexone
What are the 11 sxs for alcohol use disorder
- Recurrent drinking resulting in failure to fulfill major role obligations
- Recurrent drinking in hazardous situations
- Continued drinking despite alcohol-related social or interpersonal problems
- Evidence of tolerance or evidence of alcohol withdrawal
- Use of alcohol for relief or avoidance of withdrawal
- Drinking in larger amounts or over longer periods than intended
- Persistent desire or unsuccessful attempts to stop or reduce drinking
- Great deal of time spent obtaining, using or recovering from alcohol
- Important activities given up or reduced b/c of drinking
- continued drinking despite knowledge of physical/psychological problems caused by alcohol
- Craving or having a persistent urge to drink alcohol
what factor genetically predisposes a person to benzo dependence
family h/o alcoholism
What lab result is found to be increased in bulimia nervosa
amylase
(found in patients w/ h/o significant and frequent self-induced vomiting b/c of resulting hypersecretion from the salivary glands)
What are 5 common symptoms patients might complain of with bulimia nervosa
- fatigue
- abdominal pain
- bloating
- constipation
- irregular menses
Are calcium, magnesium and potassium high or low in bulimia nervosa
low
Is thyroid function usually normal or abnormal in bulimia nervosa
normal
which delusion?
focus on impending catastrophic event
nihilistic delusion
which delusion?
Delusions that involve romance
Often falsely believe that someone else is in love with them (person may be known or unknown)
erotomanic delusions
Which delusion?
Delusions that center around the aptient believing they have abilities that are beyond what is expected of the individual
gradiose delusion
Which delusion?
Delusions involve pt being focused on being harmed or harassed by another individual, organization or group
Persecutory delusions
(MC type of delusion seen with psychotic disorders including schizoaffective disorder)
What is mesenteric artery syndrome
Loss of the fat pad surrounding the superior mesenteric artery in severe anorexia nervosa which leads to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta, causing a small bowel obstruction.
What is a barrier to treatment in a patient w/ personality disorder
fragile self-concept
(NOT delusions of persecution- this is seen in schizophrenia)
What neurocutaneous disease has a high correlation with the development of autism?
Tuberous sclerosis
Which 2 antipsychotics have the lowest risk for tardive dyskinesia
quetiapine and clozapine
Development of a specific phobia:
What is direct conditioning
occurs as a result of being involved in a specific situation with subsequent development of the phobia
Development of a specific phobia:
What is vicarious acquisition
Result of observing or seeing someone react to a situation
Development of a specific phobia:
what is informational transmission
Hearing about something that happened to someone else and you develop a phobia to it
(ex: cousin died in MVC so now you’re scared to drive)
What 2 symptoms MUST be present as one of the 5 sxs in order to make a dx of MDD?
- Loss of interest in daily activities
- Depressed mood
What is the youngest age at which PTSD can be diagnosed
6 y/o
What is the PCL-5 used for
20 questions
effective in identifying patients w/ PTSD as well as monitoring for changes in sx severity over time
Score >38= PTSD
What are the 6 cardiac complications of Meth
- MI d/t vasospasm
- Stroke
- Malignant HTN
- Dysrhythmias
- aortic dissection
- cardiomyopathy
Which two psychiatric disorders most commonly coexist in individuals diagnosed with antisocial personality disorder?
MDD and substance use disorder
What 3 other mental disorders is attention-deficit and hyperactivity disorder also associated with?
Antisocial personality disorder
Bipolar
Autism
Which part of the brain is responsible for processing fear
amygdala
What are 2 absolute contraindications to clozapine?
h/o clozapine induced agranulocytosis or myocarditis
What are the 5 common early clues to impending delirium tremens?
anxiety
decreased cognition
tremulousness
increasing irritability
hyperactivity
