PSY Flashcards
SSRI examples
Fluoxetine
Fluvoxamine
Sertraline
Escitalopram
Citalopram
ASEPTIC mnemonic for MSE
Appearance and Behavior
Speech
Emotions
Perceptions
Thought
Insight
Content
Special parts of a PSY hx
Past psychiatric history
Family hx of psy conditions
Social hx
Occupational hx
Substance use eg smoking,drugs
Educational hx
Psychosexual
O&G
Childhood
Premorbid personality
Drugs for treatment for MDD
Bio
SSRI
SNRIs
NaSSa
Augmentation:combination, ECT,Lithium,antipsychotics
PSY: CBT
Social: interventions
Diagnostic criteria for Major Depressive Disorder
5 or more of
- Depressed mood
- Sleep disturbance
- Anhedonia
- Feelings of worthlessness/guilt
- Fatigue
- Diminished cognition(pseudodementia)
- Weight change
- Psychomotor changes(agitation or retardation)
- Suicidal ideation
Medical causes to rule out in patient with depressive symptoms
Hypothyroidism
Cushings
Cancer
Myocardial infarct
Chronic disease eg SLE
Side effects and CIs of Lithium
SEs
Polyuria
Polydipsia
GI disturbance
Fine tremor
Renal ajd thyroid dysfunction
Encephalopathy
CIs
Pregnancy: causes Ebsteins abnormality
Breastfeeding
Sodium valproate SEs
Thrombocytopenia
Liver dysfunction
Teratogen:Neural tube defects in pregnancy
Lamotrigine for bipolar SEs
SJS and dermatological
Mood stabilisers
Valproate,Lithium,Lamotrigine
Best mood stabiliser for rapid cycling and cyclothymia
Sodium Valproate
Definition of rapid cycling
4 or more episodes of depression,mania or hypomania in a single year
Definition of cyclothymia
1.Periods of sx of depression and hypomania but do not meet criteria for either
2. >2years
3. Sx present >1/2 the time
4. Sx never absent for > 2/12
Definition of treatment resistant depression
Persistence of symptoms despite 2 or more treatment trials, including haloperidol and olanzapine
Drug of choice for Treatment resistant schizophrenia
Clozapine
Examples of SNRIs
Venlafaxine and desvenlafaxine
Example of NaSSa/ Noradrenergic Selective Serotonergic antidepressant
Mirtazipine
Sx of major depressive disorder
Low mood
Anhedonia
Feelings of guilt/worthlessness
Sleep disturbance(hypersonic or insomnia)
Weight and appetite changes
Lethargy
Cognitive changes/pseudodementia
Psychomotor changes
Suicidal ideation
SEs of typical antidepressants
Haloperidol: Extrapyramidal symptoms, hyperprolactinemia
Chlorpromazine: Dyslipidemia, Weight gain/T2DM, anticholinergic, orthostatic hypotension, QTC prolongation
Type of amnesia from ECT
Retrograde
Sx of PTSD mnemonic
TRAUMA
Traumatic event
Re experiencing
Avoidance
Unable to function
More than a month
Arousal increased
+-Derealization/Depersonalization
Mx of PTSD
- Trauma focused CBT
- EMDR(Eye movement desensitisation and reprocessing)
- Pharmacotherapy: SSRI,SNRI and prazosin
Parts of risk assessment
- Harm to self
2, Harm to others - Risk of self neglect
Sx of neuroleptic malignant syndrome(NMS)
AMS
Muscle/ Lead Pipe rigidity
Hyperthermia
Autonomic instability
Sx of Serotonin Syndrome
AMS
Autonomic instability
Hyperthermia
Causes of Neuroleptic Malignant Syndrome
Excessive anti dopaminergic agents eg antipsychotics
Cause of serotonin syndrome
Serotonergic overactivity often due to use of multiple serotonergic drugs
Sx of alcohol use disorder
1.Strong desire to drink alcohol
2.Drinking more/ over a longer period than ontended
3.Tried to cut down or stop but couldn’t
4.Continued drinking despite social or interpersonal problems
5.Continued drinking despite physical/psych problems
6.Tolerance
7.Gave up important activities because of drinking
8.Drinking has a negative impact on function
9.Drinking in hazardous situations
10.Withdrawal effects
11. Spends a lot of time recovering from after effects
sx of borderline personality disorder
“1. Emotional lability
2. Easily angered
3. Feeling empty
4. Fear of abandonment
5. Self destructive behavior
6. Self harm
7. Impulsivity
8. Unstable sense of self
9. Unstable relationships
10. Suspicions and paranoid”
Cluster A personality disorders
Paranoid, Schizoid, Schizotypal( Accusatory, Aloof and Awkward)
Cluster B personality disorders
Borderline, Anti Social and Histrionic, Narcissistic ( Bad, Borderline, flamBoyant and Best)
Cluster C personality disorders
OCPD, Avoidant, Dependent(Cowardly, Clingy, Compulsive)
Dx criteria for adjustment disorder
“Emotions/ behaviors in response to a stressor that occur within 3 months of onset
Cliniclaly significant responses that include at least one of the following
-Level of distress disproportionate to the expected response to stressor
-Impaired functioning in important areas
-Not explained by grief
-Not explained by other disorders
-Symptoms last <6 months following resolution of the stressor”
Sx of Paranoid PD
“1. Pervasive Distrust of others
2. Unjustified fear of people using info against them
3. Unjustified suspicion of disloyalty of friends/family
4. Unjustified suspicion of intentions to harm them
5. Perceives benign remarks as hidden humiliations
6. Suspicions of infidenlity
7. Disproportionate rxn to perceived attacks
8. Holding grudges”
Schizoid
“1. Lack of desire for social relationships
2. Lacks people to trust
3. Lack of interest in sexual relationships
4. Prefers socially isolated activities
5. Enjoys few activities
6. Indifferent to praise or criticism
7. Flattened affect”
Schizotypal
“1. Odd appearance
2. Social anxiety
3. Socially awkward
4. Magical thinking
5. Perceptual disturbances
6. Paranoid beliefs
7. Preference for social isolation
8. Ideas of reference
9. Bizarre thinking/speech
10. Constricted affect
11. Few close friends
12.Low self esteem”
Borderline
“1. Emotional lability
2. Easily angered
3. Feeling empty
4. Fear of abandonment
5. Self destructive behavior
6. Self harm
7. Impulsivity
8. Unstable sense of self
9. Unstable relationships
10. Suspicions and paranoid”
Antisocial
“1. Manipulative, Deceitful
2. Impulsive
3. Aggressive and violent
4. Criminal activity
5. Unable to fulfil financial or work obligations
6. Disregard safety of self and others
7. Emotional indifference, unremorseful
Narcissistic
“1. Excessive sense of self importance
2. Fatntasizes disproportionately about success
3. Beliefs of superiority and being special
4. Expects favourable treatment
5. Expects admiration
6. Willing to exploit others
7. Lacks empathy
8. Often envious of others
9. Often acts arrogant”
Histrionic
“1. Attention seeking esp physical appearance
2. Uncomfortable when not centre of attention
3. Dramatic speech
4. Exaggerated EE
5. Sexually provocative behavior
6. Overestimates degree of intimacy
7. Feelings shallow and unstable
8. Easily influenced by others or circumstances”
OCPD
“1. Perfectionism that interferes with task completion
2. Excessive preoccupation with rules and lists
3. Rigid routines
4. Obsessive about work and productivity at the expense of success and relationships
5. Unwilling to delegate tasks
6.Rigid about ethics and morality
7. Clings on to worthless items
8. Miserly, saves for future disaster”
Avoidant
“1. Avoids interpersonal contact due to fear of rejection
2. Only interacts when certain of being liked
3. Restrained in intmate relationships
4. Feeling of inadequacy leading to social withdrawal
5. Hypersensitivity to criticism
6. Low self esteem
7. Avoids new activities and risks”
Dependent
“1. Disproportionate need for support
2. Difficulty making everyday decisions, wants others to take responsibility
3. Avoids disagreements for fear of losing support
4. Difficulty initiating new projets due to lack of self confidence
5. Goes to extreme measures to obtain support
6. Urgently seeks new relationships if one fails
7. Feels helpless if alone
8. Far of abandoning or being abandoned by paartner”
Withdrawal Sx of opioid use
“Withdrawal
-Muscle Aches
-Headache
-Nausea/Vomiting
-Tearing
-Rhinorrhea”
Triad of ADHD
- Inattention
- Hyperactivity
- Impulsivity
Triad of autism spectrum disorder
- Decreased Communication
- Decreased interaction and pretend play
- Stereotypies and repititive behavior
Mood stabilizer of choice in avoiding weight gain
Carbamazpine
Mx of GAD
- SSRi/SNRi for 1yr
- Buspirone
- BZDs short term or PRN
DSM V criteria for Generalized Anxiety Disorder
A. Feelings of worry and anxiety experienced more days than not for >6/12
B. Difficult for individual to control these feelings
C. 3 or more of these Sx
1. Nervousness/Restlessness
2. Insomnia
3. Somnolence, Fatigue
4. Muscle tension
5. Irritability
6. Concentration difficulties
Other psychiatric conditions often associated with OCD
Hoarding disorder and trichotillomania
Possible ddx for OCD
Hoarding disorder, trichotillomania, Tics/Tourette’s, OCPD, GAD
DSM V criteria for OCD diagnosis
Obsessions: Repetitive, unwanted and invasive thoughts surrounding contamination, harm, symmetry etc
Compulsions: Repetitive behaviors/mental exercises performed to relieve the anxiety caused by obsessions
Time consuming >1hr/day or significant distress/functional impairment
Not explained by organic or substance related causes or another psychiatric disorder
Mx of OCD
Psy: CBT and EXPOSURE AND RESPONSE PREVENTION(ERP)
Bio: SSRI/SNRI/TCA
Pathogen that has propensity to deposit on the choroid and cause endopthalmitis
Klebsiella pneumoniae
Pharm Alternatives to BZDs for improving sleep
Z-Drugs( Zopiclone, Zolpidem)
Agomelatine
Melatonin
Sedating antihistamines
Methods of testing frontal lobe function
Perseveration: Luria hand test and alternating sequence
Judgement
Cognitive estimation
abstract thinking: Kill 2 birds with one stone
Verbal fluency
Series of 7?
