OME Flashcards
1st line treatment for anorexia?
CBT + Antipsychotic
What is the best treatment for OCD?
What else?
CBT
SSRI or clomipramine (TCA)
Patient that has insomnia, what is the next step to assess the reason?
What does that mean?
of hours sleep greater or less than 6 hours
< 6 hours = fix sleep hygiene, treat underlying disease, try BENZOs
> 6 hours means adjust sleep schedule
What defines Bipolar II?
Hypomania AND major depression
Less than 4 days of duration
How do BENZOs affect sleep?
Shorten REM -> less restful sleep
Eliminate dreams
What is Gender Dysphoria definition?
> 6 months AND distress d/t 1 of 4 things:
Incongruence
Desire to be other gender
Wanting to rid of self sex char
Believe they are opp sex
Treatment for GAD?
1st line: Psychotherapy is best
2nd line: SSRI, buspirone
Psychiatric illness w/a patient on no medications that has rigidity, increase temp, and ANS instability what do they have?
Malignant catatonia
Pt that has a SBO and is missing hair most likely has what?
Need to r/o what?
Trichobezoar
Fungus
Night terrors occur in what stage?
Memory?
Tone?
Treatment?
Stage 3
No
Yes
Reassurance
What are the cluster C personality disorders?
ADO —> fear, shy
Avoidant
Dependent
Obsessive-Compulsive
What is Wernicke’s encephalopathy?
Symptoms?
Reversible lesion of cerebellum bc No B1
causes confusion, ATAXIA, ophthalmoplegia
What defines Autism spectrum disorder?
What else do they have?
Dec social communication
Restricted repetitive behaviors
Dec language
IQ impaired
ADHD defined by what timeline?
Before age 12, last > 6 months
Must occur in 2 settings or more
What is the loss of muscle tone while conscious called?
Cataplexy
What defines GAD?
Constant anxiety about almost everything
Most days >/= 6 months and have >/= 3 somatic sx
What are the nt’s of sleep and what stages do they occur?
SAND Serotonin - inc sleep ACh - Dream NorEpi - Dream Dopamine - inc awake
What are the 5 categories of PTSD?
Intrusion - nightmares, flashbacks Mood changes - Negative Dissociation Avoidance Arousal - hypervigilance
Treatment for Bulimia Nervosa?
Never use what?
Fluoxetine + CBT
Bupropion
What involves regurgitation of food for at least a month?
MC in whom?
Rumination disorder
Infants, retards
What are the MC sx of GAD?
Irritability Somatic pain Weight change Sleep change Concentration
What is intermittent explosive disorder?
Treat how?
Stressor that induces anxiety which causes person to violently act out at people or property
No benefit to SSRI or therapy therefore:
JAIL if severe
What defines insomnia?
Difficult falling asleep or waking up too early w/out falling back asleep 3 nights/wk for 3 months
Baby blues occurs with which baby?
Timing?
Depression?
Psychosis?
Treatment?
1, cares about baby
Onset and duration w/in 2 weeks
Dysthymic
None
None
What med is long acting and used for long term maintenance of opioid dependence?
Naltrexone
A girl that regresses after a period of normal development until about 6 months most likely has what?
Rett syndrome
How is Tourette’s treated?
Like what?
Antipsychotics
Risperidone (dopamine antagonist)
What defines schizophrenia?
Greater than 6 months AND 2 of 5, ONE must be 1-3
1) bizarre delusions
2) hallucinations
3) Disorganized speech
4) disorganized behavior
5) flat affect, cognitive defects, poverty of speech, anhedonia
What does SIGECAPS stand for?
Sleep - dec Interest - dec Guilt - inc Energy - dec Concentration - dec Appetite - dec Psychomotor - dec Suicide - inc
The object stolen in kleptomania is described how?
Little to no value
Pt CAN afford
Unplanned, w/OUT help
What is Tourette’s associated w/?
OCD
Paradoxical behavior, appearance changes, memory gaps (blackouts) is what?
Treat how?
DID
Psychotherapy
PCBD timeline?
Started after 6 months, lasts greater than 12 months
What defines Panic Disorder?
SOB, trembling, unsteadiness, depersonalization, excessive HR, numbness, tingling, sweating, palpitations, ABD distress, N, intense fear of losing control/dying, chest pain
What are the 2 treatment techniques to overcome specific phobias?
Describe
Systemic desensitization - start w/small amount and build up —> works best but takes longer
Flooding - anxiety response burns out —> best for time-sensitive need
What defines narcolepsy?
Dx how?
Treat how?
Rapidly plunged to REM sleep at least 3x / wk for 3 months
Low CSF hypocretin-1, polysomnography
Schedule naps, stimulants
What meds can treat enuresis?
Without meds?
Desmopressin
Oxybutynin
Imipramine
Positive reinforcement
Adjustment disorder timeline?
D/t what?
Treat how?
> 3 months, less than 6 months
Less severe stressor
No treatment needed
What are the 2 types of IED?
MC in whom?
Mild: 2x / week in 3 months w/out harm
Severe: 3x / year WITH harm
MEN
What is the key feature of schizotypal personality disorder?
Magical thinking
What are the 5 Kubler-Ross states of death and dying?
DABAD
Denial Anger Bargaining Acceptance Depression
What does DIGFASTER stand for?
Distractibility Insomnia Grandiosity Flight of Ideas Agitation, Activities Sexual Exploits Talkative Elevated Mood Racing thoughts
Moderate autism occurs when?
Presents how?
2-4
Plateau
Side effects of TCAs?
TCCAS tachycardia, HoTN cardiac conduction delay (QRS) Change in mental status AntiAch Seizures
What are the cluster A personality disorders?
PSS
Paranoid
Schizoid
Shizotypal
Definition of enuresis?
Wetting the bed is normal up until when?
2 or more times / wk for 3 months in 5 yrs or older
7
Acute stress disorder defined how?
PTSD?
Less than 4 weeks from the event
Older than 4 weeks
Pt that has Disinhibited Social Engagement Disorder has what sx?
Must r/o what?
PAIRS too much
Autism
DBT is used for treating what?
Borderline personality disorder
What are the 5 stages of substance abuse?
Pre-contemplative Contemplative Preparation Action Maintenance
What defines encopresis?
What is it?
1x or more / Month for 3 months
Shitting in public
What defines MDD?
5 SIGECAPS w/depressed mood/anhedonia for at least 2 weeks
Haldol is the BEST medicine for a pt w/acute severe mania w/psychosis except when it is contraindicated in what pts?
Prolonged QT
What are atypical features of MDD?
Increased sleep
Increased appetite/weight
Nightmares occur in what stage?
Memory?
Tone?
Treatment?
REM
YES, awake easily
No
Address stressor
When starting an SSRI, how long is an adequate trial?
1-2 months of MAX dosing
Pt that was once dry but now has bed wetting with negative UA and negative US what is the cause?
D/t what?
Regression
New sibling, sexual abuse
What defines Bipolar I?
Elevated mood + 3 sx of DIGFASTR for at least 1 week
What is anxiety in response to a mild stressor that leads to anxiety about 1 specific thing which leads to a loss of function w/out psychosis?
Adjustment disorder
Respiratory depression + mitosis in a pt indicates what?
Opiate OD
Bupropion is used for what?
Smoking
Has NO weight gain
What defines pyromania?
What is their motivation?
Fire setting 2x or more + fascination/gratification
To decrease anxiety or Increase sexual arousal —> THEY LIKE IT
ADHD characterized how?
Impulsivity
Inattention
Ex. Poor grades and bad behavior
Amnesic-Confabulatory syndrome is known as what?
What symptoms?
Pathology?
Korsakoff’s syndrome
Retrograde and anterograde amnesia, confabulation
IRREVERSIBLE
B1 Deficiency for too long
Pt that is presenting with panic disorder, what must be ruled out first?
MC pt?
ACS - troponin, EKG
Hyperthyroid = TSH
Asthma = wheezing
Female in their 20s w/no PMHx
Schizophreniform timeline?
Treat how long?
> 1 month, less than 6 month
3-6 months
Anorexia Nervosa severe signs?
Bradycardia
Leukopenia
HoTN
IDD pt w/6th grade level is what severity?
6 y/o (3rd grade)?
Age 3?
Age 1?
Mild
Mod
Severe
Profound
How long should you treat with a SSRI?
Treat for how long before changing meds?
How long for washout?
6 weeks at MAX Dose
6 months
3 weeks or more
FRAMES is used for what?
Means what?
Motivational interviewing
F - offer Feedback R - emphasize personal Responsibility A - give Advice M - Menu of option E - use Empathy S - support Self-efficacy
Describe the classic Kleptomaniac
WOMAN, object causes increased anxiety, only stealing it reduces anxiety
Feels remorse, therefore gifts, hoards, or returns item
What are the cluster B personality disorders?
BANH Borderline Antisocial Narcissistic Histrionic
What drug can be used to help opiate withdrawal?
Helps what symptoms?
Clonidine
Lacrimation, diarrhea, sweating, nausea
What is cataplexy assoc w/?
Narcolepsy
What personality disorder is characterized by being a loner, happy in isolation?
Schizoid
What is agoraphobia?
Fear and avoidance of public areas, crowds, public transportation, going outside alone
Mild autism occurs when?
Presents how?
Age 4-6
Regression
What psychotherapy treatment for panic disorder?
CBT
Grief timeline?
Features?
Less than 12 months
Waxes and wanes
Can be happy
IS insight to psychosis
People w/IED described how after the act?
Calm, relaxed, without Remorse
What is the timing for acute stress disorder?
PTSD?
> 3 days but less than 1 month
> /= 1 month
Treatment for RAD/DSED?
Find a caregiver —> parent better
What is the treatment ladder for Bipolar I?
1 - Lithium
2 - Valproic Acid
3 - Carbamazepine/lamatrogine
4 - Quietapine
Post-Partum psychosis occurs with which baby?
Timing?
Depression?
Psychosis?
Treatment?
After 1st, fears baby and will kill it
Onset w/in 1 month
None
Yes
Mood stabilizer, antipsychotic
Travel + amnesia = what?
Fugue
What defines intellectual disability disorder?
Dec cognitive skill
Dec adoptive function
What is depersonalization disorder?
Derealization?
Dissociation from your BODY
From the environment
What is the stressor for reactive attachment disorder?
Evident when?
What is impaired?
Neglect or abuse
Less than 5 y/o
Ability to PAIR/bond
Depression (MDD) in the setting of death of a loved one has what timeline?
What features
Duration greater than 12 months
Hallucinations
Hopeless, NEG self
Anorexia nervosa is categorized by what?
What are they?
Weight
Mild - BMI > 17
Mod - 16 - 16.9
Severe/Extreme —> < 16
Catatonia is treated how?
Refractory cases treated how?
Pts at risk for what?
Lorazepam
ECT
DVT, Rhabdo (Inc CK)
Dysthymia defined how?
Treat how?
Rule out what?
Depressed mood for > 2 years but w/out symptoms > 2 months at a time
SSRI
Thyroid - get TSH
MC social phobia?
Treat how?
Public urination, public speaking
Beta blockers, CBT
Brief psychotic disorder timeline?
> 1 day, less than 1 month
What is Cataplesy associated w/?
Catatonia
What are the stages of sleep with wave forms?
BATS Drink Blood
Beta - awake Alpha - drowsy Theta - Stage 1 Spindles and K complexes - Stage 2 Delta - Stage 3 Beta - REM
Treatment for PTSD or ASD?
Group therapy is the BEST
Then use SSRI/SNRI
What defines cyclothymia?
At least 2 years of hypomania and a MDE
Acute opioid overdose use what medicine?
Naloxone
What medication is useful in treating nightmares and sleep disruption in PTSD?
MOA?
Prazosin
Alpha-1 blocker that blocks adrenaline receptors
What is Flumazenil used for?
Benzo OD
At what stage is it hardest to arouse?
3
What does GABA do to sleep?
Decrease Stage 3
Decrease Sleep latency
OSA can lead to what health complications?
Treatment?
Pulm HTN —> RHF
CPAP, lose weight
For pts w/IDD what IQ score is no disability? What adaptive fxns?
Mild?
Mod?
Severe?
Profound?
> 70 no restriction
50-70 no advanced life skills
35-49 no advanced life skills, cannot work
20-34 no ADLs
< 20 total care
Binge-Eating Disorder patients are described how?
Overweight, NO purge
Post-Partum depression occurs with which baby?
Timing?
Depression?
Psychosis?
Treatment?
After 1st, doesn’t care about baby, may hurt
Onset w/in 1 month
MDE
None
SSRI
What causes central sleep apnea?
Look for what?
Treat how?
Opiates, COPD, idiopathic, CVA
Cheyenne-Stokes breathing
BiPAP
