Notes Flashcards
Grief vs MDD (timeframe)
If > 2 mo then MDD
Abnormal grief (6 items)
GUILT NOT directly related to E.O.L SI NOT "better off dead" Preoccupation with WORTHLESSNESS PMR Prolonged functional IMPAIRMENT HALLUCINATIONS (beyond voice image of deceased)
Hypomania becomes mania when …
last MORE than 7 days OR
patient hospitalized OR
accompanied by psychosis
Erickson (7 stages)
0-18 mo: trust vs mistrust
3-5: initiative vs guilt (autonomy to explore)
5-13: industry vs inferiority (sense of self through creation)
13-18: identity vs role confusion
Young Adult: intimacy vs isolation
40-60: generativity vs stagnation (view of role in society)
Late life: ego integrity vs despair (place in life cycle vs unfulfilled desire
SSRI longest half life, how long, out of system in?
fluoxetine, 54 hours, 9 days
SSRI highest rate of QTc prolongation, at dose?
citalopram, at >40mg
Most associated with discontinuation syndrome and ADR?
paroxetine
SSRI with starting dose 20 mg (3)?
fluoxetine, citalopram, paroxetine
SSRI with starting dose 50 mg (2)?
sertraline, fluvoxamine
SSRI with starting dose 10 mg (1)?
escitalopram
SSRI shortest half life?
fluvoxamine 18 hours
SSRI not on $4 list?
escitalopram
Adequate SSRI trial?
6-8 weeks at treatment dose
OCD dosing for SSRIs? (3)
fluoxetine 60-80 mg
sertraline 250-300 mg
If refractory then high dose fluvoxamine
First gen anti psychotics (4)
haloperidol, chlopromazine, perphenazine, fluphenazine
FGA side effects (3)
tremors, tardive dyskinesia, dystonia
SGA side effects (4)
weight gain, increased lipids, DM risk, increased appetite
Antipsychotic with breast formation
risperidone (due to incr. PRL)
Antipsychotic with QTc prolongation but less weight gan
ziprasidone
Antipsychotics with highest weight gain, DM risk, and sedation
Olanzapine (more weight gain) and quetiapine (more sedating)
Weight neutral antipsychotic
Aripiprazole (can gain or lose weight)
Effect of clozpaine of Schizo suicide rate
10% –> 2-3%
Cigarettes affect metabolism via?
CYP1A2 (40% drop in clozapine and others metbaolized by 1A2)
Clozapine side effects (3)
Agranulocytosis (0.8%, 0.4% on other anti-psychotics)
Myocarditis (rate as above)
Metabolic effects
GAD drugs
SSRI, TCA, Buspar, benzos
Panic drugs
SSRI, TCA, benzos, MAOi
Hyperarousal drugs
a1-antag, b-blocker, a2-agonist
Hyperarousal center in brain?
Locus ceruleus
Hypothalmic stimulates appetite
lateral
Hypothalmic suppresses appetite
ventromedial
Hypothalmic controls arousal
posterior
Hypothalmic sexual behavior
anterior
Hypothalmic makes ADH
supraoptic
Schizophrenia prevalence in kids, siblings, parents
Kids 12.8%
Siblings 10%
Parents 5.9%
RISK FOR FIRST DEGREE RELATIVES IS ELEVATED BY 0.9%
ADHD with bedwetting drug?
imipramine
ADHD with tics drug?
clonidine
LItihum onset of action?
7-14 days
Hyperarousal center?
Locus ceruleus
kid refusing to eat 7,8,9 not to do with fat
ARFID
Confusion with neck rash
Niacin or thiamine
somatization complaints
4 pain, 2 GI, 1 sexual and 1 pseudo neuro
4 (hypo)manic in 12 mo =
rapid cycling
4 Ds of malpractice
DUTY to patient
DEVIATION from standard of care
DIRECT CAUSAL relationship to bad outcome
DAMAGES occurred
DSM AXES
1 - psych disorders 2 - personality disorders 3 - medical probs 4 - preceding events 5 - fucntioning
How to tell epileptic seizures from non
incr PRL in epi, and EEG activity
How long do you have after seizure to check PRL?
20 min
RLS three comorbidities?
Pregancy, renal failure, metabolic disorders
2 high/med/low potency antispcyhotics
High: haldol, fluphenazine
Med: Perphenezine, molidone
Low: Chlorpromazine, thioridazine
ADRS with low potency
Anti-cholinergic
Carbamazepine ADRs
aplastic anemia, steven johnson
Tourettes drugs
Haldol (& anti-psyhcotics), a2-agonists, CCBs
5 classes of drugs that cause depression
corticosteroids OCPs Thyroid meds HTN meds Parkinson meds
Med for opiate withdrawal
clonidine
Shortest acting benzo & 2 long acting
fluorazepam vs lorazepam and oxazepam
Dysphoric mania means …
mixed state
Stable self theorist?
Kohut
Bupropion has higher or lower risk than SSRI to induce mania?
Lower!
Cyclothymia and dysthymia timeframe?
2 years