Pschiatry Flashcards
What patients are more likely to fail ECT?
Those who have had a prolonged episode, lack of response to medication, and coexisting psychiatric diagnoses such as personality disorder.
What are the absolute contraindications to ECT?
There are no absolute contraindications. Persons who may be at increased risk for complications include those with unstable cardiac disease such as ischemia or arrhythmias, cerebrovascular disease such as a recent cerebral hemorrhage or stroke, or increased intracranial pressure. ECT can be used safely in elderly patients and in persons with cardiac pacemakers or implantable defibrillators. It can also be used safely during pregnancy, with proper precautions and in consultation with an obstetrician.
Features of OCD in adults
The patient at some point recognizes that the obsessions/ compulsions are unreasonable. The O/C are not related to worries about one’s probs. Pt experiences marked distress because of the impulses. Full remission is rare, but tx can provide significant relief.
What additional drugs are likely to be helpful for a depressed patient who initially responded to an SSRI but has become resistant to it?
Both lithium and low-dose triiodothyronine have been shown to be helpful. Thyroid supplementation should be given at a dose no higher than 50 µg per day. Atypical antipsychotics can also be used but they are not as effective as lithium or T3. Anticonvulsant medications such as gabapentin have been shown to be effective in the management of bipolar affective disorder but not as adjunctive therapy in the treatment of unipolar depression resistant to single agent antidepressants.
What are the features of borderline personality disorder?
Patterns of unstable and intense interpersonal relationships, of impulsivity that is potentially self damaging, of self mutilating behavior, of inappropriate intense anger or affective instability due to marked mood reactivity which last a few days at a time.
What is the pharmacological treatment for obsessive-compulsive disorder?
SSRIs such as fluoxetine and fluvoxamine are FDA approved and considered first-line agents for this condition.
What antipsychotic is recommended for persons with Parkinson’s who become psychotic?
Quetiapine or Seroquel because it has no clinically significant effect on dopamine D2 receptors.
What antidepressant is preferred for patients who are on multiple other medications?
Citalopram or Celexa. It is the least likely SSRI to inhibit the cytochrome P450 system.
What does each axis represent and diagnosing mental disorders?
Axis I: clinical syndromes such as depression, anxiety, OCD, bipolar disorder
Axis II: developmental and personality disorders which include autism and mental retardation
Axis III: physical conditions that play a role in the development, continuance, or exacerbation of axis one and two disorders.
Axis IV: psychosocial stressors which include events which can impact the axis I and II.
Axis V: global assessment of functioning or GAF. This is a rating of patients level of function both at the present time and the highest level within the previous year from 0 to 100.
What two questions are a good depression screen?
- Over the past two weeks, have you ever felt down, depressed, or hopeless?
- Have you felt little interest or pleasure in doing things?
What are the diagnostic criteria for depression?
The patient must have either a depressed mood or anhedonia combined with three or four of the following: appetite or sleep changes, decreased energy or concentration, thoughts of guilt or death, and psychomotor changes such as restlessness or slowing.
What are the diagnostic criteria for dysthymia?
It requires a depressed mood for at least two years with no symptom-free period lasting longer than two months along with two or more of: appetite and sleep changes, decreased energy or concentration, thoughts of guilt or death, and psychomotor changes such as restlessness or slowing.
What is unusual about bupropion?
It has no sexual side effects, and it increases the risk for seizures.
What is unusual about venlafaxine?
Effexor: It is an SNRI and it is very good for anxiety and panic attacks.
What is unique about nefazodone?
( Serzone). It has no sexual side effects and is extremely sedating. It can cause liver dyscrasia and is therefore a second line drug.
