New3 Flashcards
1
Q
Lithium Toxicity Signs Acute
A
- GI - Nause, vomiting, diarrhea
- Cardaic - can cause EEG changes but it is rare
- Neurological - slugishness, ataxia, confusionm agitation, neuromuscular excitiability (tremor, fasciculations, myoclonic jerks)
2
Q
SILENT
A
- Syndrome of irriversible lithium neurotoxicity - prolonged neurological and neuropsychiatric symptoms.
- Symptoms persist despite successful removal of the drug.
- Cerebellar dysfunction, extrapyramidal symptoms, brainstem dysfunction, and dementia can develop as part of SILENT
3
Q
Chronic toxicity
A
- Neurologic - Ataxia, confusion or agitation, and neuromuscular excitability. Severe can result in seizure, nonconvulsive status epilepticus, and encephalopathy.
- Cardiac - Can have EEG changes but its rare
- Renal - diabetes inspidus. Volume depletion can occur, may develop hypernatremia
4
Q
DSM-5 Depression Specifiers
A
- Melancholic - nonreactive mood, anhedonia, weight loss, guilt, psychomotor retardation or agitation, moring worsening of mood, early morning awakening.
- Atypical - reactive mood, oversleeping, overeating, leaden paralysis, interpersonal rejection sensitivity.
- Psychotic - hallucination or delusions
- Catatonic - waxy flexibility, catatonic excitement, negativism or mutism, mannerisms or stereotypes, echolalia or echopraxia
- Anxious - tense, restless, worried, something awful may happen, afraid or losing control
- Mixed- elevated mood, inflated self-esteem or grandosity, increase talking, racing thoughts, increase energy and activity, decrease sleep, risking impulsive activities
- Seasonal affective - regular onset and remission of depressive episodes during particular season
- Peripartum - onset duirng pregnancy or within 4 weeks
5
Q
Serious (but uncommon) adverse effects of antidepressants
A
- QT prolongation (surrogate marker for Torsafe de Pointes) is a warning for citalpram, escitalopram, and quetiapine. However, Torsade is an idiosyncratic events, and its association with antidepressant meds in unclear.
- Long term use of SSRI - increase risk of falls and fractures
- Hyponatremia in SSRI use in older patients
- SSRIs can inhibit platelet aggregation by altering platelet serotonin receptors and increase risk of GI bleeds
- Agomelatine - requires livers function testing as it has potentual to elevate liver enzymes
6
Q
Clinically relevant drug-drug interactions
A
- Antidepressants and antipsychotics are primarly metabolized through CYP450 enzymes
- Agomelatine and duloxetine are metabolized via CYP1A2 pathways, and should not be coadministered with drugs that block this pathway.
- Vilazodone is metabolized through CYP3A2 pathway and should be used cautiously when prescribed with CYP3A4 inhibitors
- Clinically relevants interactions are usually caused by agents that are potent CYP inhibitors - fluoxetine, paroxetine, and fluvoxamine
- Interactions with moderate CYP inhibitors (bupropion, duloxetine, and sertraline) are rarely clinically relevant except at higher doses.
7
Q
Discontinuations Syndrome
A
- Occurs when you stop using an antidepressant withut tapering
- F - flu-like symptoms
- I - insomnia
- N - nausea
- I - imbalance
- S - sensory disturbances
- H - hyperarousal
8
Q
Adjunctive Strategies depression
A
- Atypicals
- Aripiprazole 2-15mg
- Quetiapine 150-300mg
- Risperidone 1-3mg
- Antidepressants - mirtazapine
- Other - lithoum, stimulatns
9
Q
What defines a psychiatric disorder in children?
A
- Developmentally inappropriate
- Severity, frequency, duration are atypical
- It impairs school performace, peer and family relationships, community activities
- Not simply an unaccommodating environment
- The behaviour is abnormal always
10
Q
Evaluation of children and adolescents
A
- Want information from multiple informants, multiple visits, and multiple forms of gathering the information
- Review school reports, psychoeducation testing, and previous assessments
*
11
Q
Externalizing disorders children
A
- ADHD
- ODD
- CD
12
Q
ADHD
A
- A neurodevelopmental disorder (disorder of brain structure and function)
- 3 subtypes: inattentive, hyperactive/impulsive, combined
- inattentive, distractbile, forgetful, “thoughtless”
- Overactive, hyper, excessivelt talkative
- Impulsive, intrusibe, insenstive, risk takers
- M>F, however, female may be overlooked because they tend to be inattentive subtype which is less noticable.
- In order diagnosis needs to be in multiple domains, persistent, and impairing
13
Q
ADHD Treament
A
- Pills and Skills
- Stimulants - use long acting as first line treatment
- Methylphenidate and related compounds
- Amphetamine and related compounds
- Must do cardiac screening if there is a family history of cardiac problems or personal history of cardiac symptoms
- Side effects - weight loss, irritability, increase HR, and increase BP, tics if vulnerable
- Non-stimulant - atomoxetime, bupropion, TCAs, Clonidione, Guanfacine
- Skills - behaviour modification (parents behaviour training, school modifications), social skills training
14
Q
ODD
A
- Consistent pattern of negativistic, hostile, vindictive, and defiant behaviours. Generally in multiple environments, but can still have diagnosis if only in one environment
- Behavioural management training is the treatment - parent-child interaction therapy, problem solving skills training, parent management training
- There are no specific medications for ODD, but you can treat co-morbid conditions
15
Q
ODD Prognosis
A
- 2/3 will no longer meet critieria in 3 years
- Younger age onset - more likely to continue to be symptomatic
- Irritability sx predicts later anxiety and depression
- Headstong sx predicts later CD
- Hurtful (vindictive) sx predicts aggressive CD (most serious form of CD)
