Psyc Flashcards
Postpartum…
Blues? Depression? Psychosis?
Postpartum Blues
- Onset: 2-3 days - peaks D5 resolves by 2wks
- SX: mild depression, tearfulness, irritability
- TX: reassurance & monitoring
Postpartum Depression
- Onset: 4-6 wks. can last 1 yr
- SX: >2wks of moderate to severe depression, sleep or appetite disturbance, low energy, psychomotor changes, guilt, concentration difficulty, suicidal ideation
- TX: antidepressants, psychotherapy
Postpartum Psychosis
- Days to weeks
- SX: delusions, hallucinations, thought disorganization, bizarre behavior
- TX: antipsychotics, antidepressants, mood stabilizers + HOSPITALIZATION = DO NOT LEAVE MOTHER ALONE WITH INFANT
Pt has depression + Neuropathic pain. best drug? class?
SNRI = Duloxetine
3 SSRI’s safe in kids?
Fluoxetine, Sertraline & Fluvoxamine
Alcoholic Withdrawal Seizures
time frame? tx? sx?
48hrs = tonic-clonic seizures
tx: CT to R/O other cause
Voyeurism
recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing.
*must be more than 6months of sexual arousing w/impairment of functioning
pt presents with: Orthostatic headache, Tinnitus & clear bilateral nasal discharge. dx? how woudl u dx?
Low Cerebrospinal Fluid(CSF) Pressure Headache: - Sx: o Orthostatic headache o Tinnitus o Neck pain/stiffness o NV, dizziness, vertigo, anorexia - Dx: if nasal discharge = test w/Beta-2-transferrin = CSF specific marker - 4% are idiopathic
Hypnogogic & Hypnopompic hallucinations
hallucinations that occur as patient is going to sleep or as they wake up
Suicide Risk Factors
men, older adults, social isolation, presence of psychiatric illness/drug abuse, percieved hopelessness, previous attempts
side fx clozapine
agranulocytosis = reserved for tx resistant shit
Defense Mechanism: Denial
used to avoid somthing painful “i know i do not have cancer”
Conversion Disorder
one or more neurologic sx that cannot be explained by any medical shit + psychologic factor associated with onset, PATIENT IS NOT CONCERNED ABOUT IMPAIRMENT
*bf broke up with me and now my arm doesnt work.
Obsessive-Compulsive Personality Disorder
individuals are preoccupied with orderliness, perfection, and control. They are often consumed by the details of everything and lose their sense of overall goals. they are strict and perfectionistic, overconscientious and inflexible. Associated with difficult interpersonal relationships.
Masochism
recurrent urge or behavior involving the act of humiliation or pain
*must be more than 6months of sexual arousing w/impairment of functioning
Cluster A personality Disorders
Weird = Paranoid, Schizoid, Schizotypal
Defense Mechanism: Displacement
An emotion or drive is shifted to another that resembles the original in some aspect.
“i had to get rid of the dog since my husband kicked it every time we had an argument”
Penetration Disorder
involentary constriction of outter 3rd of vagina causing pain on penitration
tx: psycotherapy & dilator therapy
Cataplexy
sudden loss of M tone; precipitated by loud nose or emotions = this is the person who laughs and collapses
*if this occurs 3x per week for 3m = narcolepsy
Binge Eating Disorder
sx? tx?
sx: recurrent episodes of binge eating 3x per weeks for more than 3 months
tx: TOPIRAMATE > SSRIs & CBT
timeline: schizophrenia, schizophreniform, brief psychotic disorder
phrenia = >6m
phreniform = 1-6m
brief psychotic disorder = <1m
Akathisia
sx? tx?
weeks to chronic use
sx: motor restlessness, do not mistake for anxiety or agitation
tx: reduce the dose; add Benzo or BB, switch to newer drugs
tx of cocaine/amphetamines withdrawl
bupropion and/or bromocriptine
sx of Dementia
memory? word findng? indep & functioning?
Dementia/Major Cognitive Disorder:
- Memory Loss: cannot remember specific instances of forgetfulness, family is more concerened than pt, has notable decline in memory for recent important events & conversations
- Word-finding: frequent with substitutions, some receptive aphasia
- Independence & Functioning: becomes dependent on others for ADLs, unable to operate common appliances, loses interest in social activities, gets lost for hours in familiar territory while driving or walking
Defense Mechanism: Repression
an idea of feeling is withheld from conciousness; unconcious forgetting
Malingering Disoder
person fakes sick knowningly to get $$$$$
ethnic group with the highest rates of suicide?
Native Americans
which atypical antipsyc has the least risk of DM & weight gain? which has the most?
most = olanzapine least = aripiprazole
tx of opiate intoxication
naloxone
Defense Mechanism: Suppression
conscious forgetting; only consciouse defense mechanism
“i would rather talk about my operation after the party is over”
Acute Dystonia
sx? tx?
seen in 1st week
sx: Mspasms, difficulty swallowing
tx: reduce dose of drugs or Anticholinergics(benztropine, diphenhydramine, Trihexyphenidyl)
Autism Spectrum Disorder
sx? tx?
M > F; before 3 yoa, lack of peer relationships, odd preoccupation with repetitive activities
tx: family counseling, special ed
Serotonin Syndrome
hx of SSRI, agitation, hyperreflexia, hyperthermia, Mrigidity, volume contraction secondary to sweating an dinsensible fluid loss
tx: ciproheptadine, benzo
Schizoaffective Disorder
Schizo + mood disorder like depression or bipolar(can be schizo & have mania!)
**lifetime hx of delusions or hallucinations for >2wks in teh absence of major depressive or manic sx
Barbiturates and Benzos sx
inappropriate sexual or aggressive behavior, impaired memory or concentration
Paradoxical Agitation seen with Benzodiazepines
Paradoxical Agitation seen with Benzodiazepines = old ppl metabolize benzo slowly = increased risk of confusion & increased risk of falls
- Old dude who gets irritated and cranky after taking his nightly meds which include Alprazolam.
- Usually occurs within 1 hr of administration
Transvestic Fetishism
recurrent urge or behavior involving cross dressing or sexual gratification; usually found in heterosexual males
*must be more than 6months of sexual arousing w/impairment of functioning
Side effects for Valproate
o Valproate Side FX: • Tremors, weight gain, GI disturbances • ALOPECIA • TERATOGENIC • HEPATOTOXIC = THROMBOCYTOPENIA • SEVERE TOX: hyponatremia, coma, death o Lamotrigine Side FX: Stevens-johnson Syndrome
Gentiopelvic Pain disorder/dyspareunia
pain with sexual intercourse not due to medical condition
tx: psychotherapy
inhalants sx
belligerence(agressive), apathy, assaultiveness, impaired judgement, blurred vision, stupor, coma
Amphetamines & Cocaine sx? withdrawl?
euphoria, hypervigilance, autonomic hyperacitivity, weight loss, PUPIL DILATION, disturbed percetpion, stroke, MI
withdraw: anxiety, tremors, increased appetitie, depression, RISK OF SUICIDE!
which antipsychotic is safe in prego?
LURASIDONE
Dissociative Amnesia
Dissociative Amnesia = inability to recall important personal information, usually tramatic or stressfull in nature; not explained by another disorder
- Ex: dude found wondering airport after wife asks for divorce, he doesn’t know who he is or how he got there. Wife says he disappeared after she asked for divorce.
MC method of suicide by both men and women?
firearms
narcolepsy tx?
scheduled naps, Modafinil +- methylphenidate and dextraamphetamine
how long for alcohol withdrawal?
5-10days
Defense Mechanism: Sublimation
sublimation is a mature type of defense mechanism, in which socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or behavior, possibly resulting in a long-term conversion of the initial impulse.
Eating Disorder not otherwise specified
anything that doesnt make the cirteria for other shit. EX: use of compensatory behavior after eating normal amounts of food
tx of paraphilias?
psychotherapy, SSRIs or antiandrogens to reduce sexual drive
Exhibitionism
recurrent urge to expose onself to strangers
*must be more than 6months of sexual arousing w/impairment of functioning
OCD tx
Obsessive-Compulsive Disorder:
- DX:
o Obesssions
Recurrent, intrusive, anxiety provoking
Attempts to suppress
Not related to substance abuse or other illness
o Compulsions
Response to obsessive thoughts with repeated behaviors or mental acts
Excessive behaviors intended to reduce anxiety or avoid dreaded outcome
Behaviors not connected with realizstically with preventing anxiety or fear
- TX:
o CBT or HD SSRI
o 2nd Clomipramine
o 3rd ECT
Schizoid Personality Disorder
detachment and restricted emotionality = emotionally distant & fear intimacy, absorbed with their own thoughts and feelings and disinterested
*main defense is projection
MDD sleep changes?
- Increase sleep latency(time it takes to fall asleep) & decreased REM latency(time it takes to hit REM sleep)
Mild Intellectual Disability
IQ? features?
IQ 50-79; 6th grade level, can live independently in a community or with minimal supervision
Illness anxiety disorder
person isnt sick but is freaking the fuck about baout becomming sick ~AT LEAST 6 MONTHS
MC method of suicide by women?
pills/poisons
Sadism
recurrent urge or bahvior involving acts in which physical or psychological suffering of the victim is exciting
*must be more than 6months of sexual arousing w/impairment of functioning
hallucinogens/LSD sx
ideas of reference(the notion that everything one perceives in the world relates to one’s own destiny), hallucinations, impaired judgments, dissociative symptoms, pupil dilation, panic, tremors, incoordination
Pedophilia
recurrent urges or arousal toward prepubescent children
*must be more than 6months of sexual arousing w/impairment of functioning
Neuroleptic Malignant Syndrome
sx? tx?
anytime!
sx: M rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC & CK
tx: stop drugs! Dantrolene or Diazepam, Bromocriptine
Disruptive Mood Dysregulation Disorder
child with prevasively angry or irritable mood involving frequent aggressive outburts that are out of proportion to the stressor do not return to normal mood after the stressor.
sx begin before 10 yoa & lasts for 12 months
Seasonal affective disorder
depression in winder months = phototherapy or sleep deprivation
Severe Intellectual Disability & Pround ID
IQ? features?
Severe: IQ 20-35
Profound: <20
Cant live on their own, need full time help
Defense Mechanism: Splitting
“the morning staff is perfect, the evening staff is terrible”
2 benzo that can be used with alcohol withdrawl
lorazepam & oxazepam = safe on liver
chlordiazepoxide = toxic to liver but can still be used
Depersonalization/Derealization Disorder
Depersonalization/Derealization Disorder = persistant or recurrent experiences of 1 or both: depersonalization(feelings of detachment from, or being outside of observer of, one’s self) and/or derealization(experiencing surroundings as unreal)
Defense Mechanism: isolation
separation of an idea form the affect that accompanies it
“as she arrived at the station to identify the body, she appeared to show no emotion”
Cluster C Personality Disorders
Worried = Avoidant, Dependent, Obsessive-Compulsive
Narcolepsy
- DSM5:
o Recurrent Lapses into sleep or naps(3x per weeks for 3 months)
o At least 1 of the following:
Cataplexy: Brief loss of muscle tone precipitated by strong emotion(laughter, excitment)
Low CSF levels of hypocreti9n-1
Shortened REM sleep latency - Associated: Hypnagogic of Hypnopompic hallucinations(hallucinations before and after nap), Sleep paralysis
Defense Mechanism: Blocking
temporary block in thinking “i have known him for years but can never seeem to remember his name”
Anorexia Nervosa vs buliemia
side effects?
KEY IS LOW BMI <18!!! *both have great concern over weight
fx: hypotension, bradycardia, lanugo hair, edema, EKG changes as a result of K deficiency
*buliemia will have binge eating + compensatory behavior but normal BMI
PCP sx
panic reactions, assaultiveness, agitation, NYSTAGMUS, HTN, seizures, coma, hyperacusis
Defense Mechanism: Regression
return to an earlier stage of dvelopment, most immature
*9yo kid starts wetting his bed in response to parents divorce
Dependent Personality Disorder
Submissive and clinging behavior related to a need to be taken care of. individuals are consumed with the need to be taken care of. they are clingy and worry about abandonment. they feel inadequate and helpless and avoid disagreements with others. they usually focus dependency on a family member or spouse
Ramelteon use? C/I?
mimics melatonin = good for pt who need help falling asleep
C/I: hepatic impairment, severe sleep apnea, severe COPD
Schizotypal Personality Disorder
discormfort with social relationshps, thought distortion, eccentricity = like schizoid but have magical thinking, vlairvoyance, ideas of reference or paranoid ideation = sx arnt severe enough for schizophrenia
Adjustment Disorder
tx?
normal anxiety, depression, irritablity within 3 months of stressful event
tx: psychotherapy
MCC of death in Anorexia Nervosa?
arrhythmia
Alcohol intoxication sx
talkative, sullen(bad tempered/moody), gregarious, moody
Normal grief vs MDD
NORMAL GRIEF/BEREAVEMENT <1Y = sadness, tearfulness, decreased sleep, appetitie, interest in the world - Sx wax and wane - Shame and guilt are mild - Usually resolves in 2m - Tx: supportive
MAJOR DEPRESSIVE DISORDER >1Y = sadness, tearfulness, decreased sleep, appetite, interest in the world - sx are pervasive and unremitting - shame and guild are SEVERE - threaten suicide often -tx: antidepressants
Minor Alcohol withdrawal
time frame? tx? sx?
6hrs, Insomnia, tremulousness, mild anxiety, HA, diaphoresis, palpitations
tx: B1, Folate, Multivitamin and Glucose
Fetishism
use of nonliving objects usually associated with the human body
*must be more than 6months of sexual arousing w/impairment of functioning
Cyclothymia
tx?
recurrent hypodepression + hypomania for at least 2 years
- patient describes low energy, fatigue times & other times of feeling up and optomistic
tx: phototherapy
Frotteurism
rubbing, usually ones penis or erect penis, against a nonconsenting person for sexual gratification
*must be more than 6months of sexual arousing w/impairment of functioning
Factitious disorder
person fakes sick so they can be patient; does this knowningly
Paranoid Personality Disorder
distruct and suspiciousness in motives and actions of otheres, often secretive and isolated, emotionally cold and odd, often take legal action against other ppl
- main defense = projection
- dont confused with paranoid schizophrenia
tx of rapid cycling bipolar disorder when Li is ineffective or C/I?
DIVALPROEX
Bradykinesia(Parkinsonism)
sx? tx?
weeks
sx: bradykinesia, tremors, rigidity, sx of parkinsons
tx: reduce dose of drugs or Anticholinergics(benztropine, diphenhydramine, Trihexyphenidyl)
Alcoholic Hallucinosis
time frame? sx?
12-24 hrs, visual hallucinations +/- tactile and auditory
*if hallucinations are present with AMS then its not due to alcohol
Major Depressive Disorder
depressed mood of anhedonia lasting 5/9 lasting 2+ weeks:
SIGECAPS: Sleep changes, Interest loss, Guilt/worthlessness, Energy loss, Concentration difficulties, Appetitie loss/gain, Psychomotor changes, Suicide
PCP sx
panic reactions, assaultiveness, agitation, NYSTAGMUS, HTN, seizures, coma, hyperacusis
Delirium Tremens
time frame? sx?
48-96hrs = hallucinations, disorientation, tachycardia, hypertension, low-grade fever, agitation and iaphoresis
**look for person who hasnt had booz in 2days!
Sleep paralysis
patient is awake but unable to move; this typically occurs upon awakening
Dysthymia
Persistent depressive disorder = hypodepression lasting most days for at least 2 years
Moderate Intellectual Disability
IQ? features?
IQ 35-50; 2nd grade level, can live in residential community settings, may be able to do some acitivties of daily living
side fx of Li
o Lithium
<2.5 = mild tox = flush with saline
>2.5 = dialysis
Side FX:
• Adversely affect the kidneys & thyroid
o Tubulointerstital nephropathy
o NEPHROGENIC DI
• Tremors, weight gain, GI disturbances
• TERATOGENIC
• LEUKOCYTOSIS
• SEVERE TOX: confusion, ataxia, lethargy, abdominal reflexes
C/I: CKD, Heart disease, Hyponatremia or diuretic use
Baseline studies: BUN, Cr, Ca, U/A, Thyroid function tests, ECG in pt with coronary risks
Tardive Dyskinesia
sx? tx?
months to years
sx: choreoathetosis and other involuntary movements after chronic use; often irreversable
tx: stop older drugs and switch to newer drugs = sx will worsen ofter drugs stopped initially
tx of barb/benzo intoxication
Flumazenil
Which 2nd gen antipsyc has least risk of tardive dyskinesia
clozapine
Bipolar Disorder
sx of mania?
depression + hypomania = 2
mania = 1
^for at least 1 week.
Mania: DIG FAST
Distractibility, irresponsibility, gradiosity, flight of ideas, activity increased, sleep is decreased, talkativeness
Defense Mechanism: Dissociation
splitting off of the brain from conscious awareness
“i heardly remember getting to the hsopital after my husband was hit by a car”
which antipsyc can cause QT prolongation
thioridazine & ziprasidone
Sexual Identity, Gender Identitiy, Gender Role, Sexual Orientation
Sexual Identity = based on secondary sexual characteristics
Gender Identitiy = who they identify with = usually figured out by age 3
Gender Role = based on external patterns of behavior
Sexual Orientation = persons choice of love object
Defense Mechanism: Introjection
“resident physician dresses like the attending whom he admires”
Cannabis sx?
impaired motor coordination, impaired time perception, social withdrawal, increased appetitie, dry mouth, tachycardia, conjunctival redness
Defense Mechanism: Undoing
“i need to wash my hands whenever i have these thoughts”
Undoing is a defense mechanism in which a person tries to ‘undo’ an unhealthy, destructive or otherwise threatening thought or action by engaging in contrary behavior. For example, after thinking about being violent with someone, one would then be overly nice or accommodating to them.
Cluster B Personality Disorders
Wild = Histrionic, Boarderline, Antisocial, Narcissistic
Intermittent explosive disorder
tx?
aggression out of proportion to the stressor. >6yoa occuring 2x wk for more than 3m or involve destructive episodes 3x within 12m period. *pt return to normal mood after stressor
tx: SSRI & mood stablizers
Sleep attack
episodes of irresistable sleepiness and feeling refrshed upon awaking = pt will not collapse
Delusional Disorder
sx? ddx? tx?
Delusional Disorder - SX: o >1 delusion for >1m o No other psychotic sx present o Ability to function apart from delusion; behavior not bizarre or odd - DDX: o Schizophrenia: other psychotic sx not present(no hallucinations, disorganization negatie sx) o Personality disorders - TX: o Antipsychotics, CBT
Defense Mechanism: Somatization
psychic derivatives are converted into bodily symptoms. = thinkin of an exam makes you feel sick
Conduct vs Oppositional defiant disorder
Conduct: bullying, fighting, cruelty to people or animals, rape, vandalism
Oppositional Defiant: typical teen anger, not present with friends
Which mood stabalizer can cause alopecia
valproate
all 2nd gen/atypical antipsycs have a risk of
DM & weight gain
Suicide Protective Factors
connection to family, pregnancy, responsibility for children, religious affiliation
Barbiturates and Benzos sx
inappropriate sexual or aggressive behavior, impaired memory or concentration
Opiates sx
apathy, dysphoria, CONSTRICTED PUPILS,drowsiness, slurred speech, impaired memory, coma, death
Defense Mechanism: Projection
attributing your own wishes, thoughts, or feelings onto someone else
ex: ‘im sure my wife is cheating on me”
Dissociative Identity Disorder
Dissociative Identity Disorder = marked discontinuity in identity & loss of personal agency with fragmentation into >2 personality states.
- Aka split personality disorder
Obsessive-Compulsive Personality Disorder
individuals are preoccupied with orderliness, perfection, and control. They are often consumed by the details of everything and lose their sense of overall goals. they are strict and perfectionistic, overconscientious and inflexible. Associated with difficult interpersonal relationships.
Premature Ejaculation
ejaculation just before or just after penitration
tx: stop & go, Squeeze technique, SSRIs
Gender Dysphoria(Formerly Gender Identity Disorder)
persistent discomfort and sense of inappropriateness regarding patients assigned sex
tx: psychotherapy & reassignment surgery
Defense Mechanism: Reaction Formation
an unacceptable impulse is transfored in to its opposite, results in the formatino of character traits
“listen to him tell his family he was not afraid, when i saw him crying”
Histrionic Personality Disorder
colorful, exaggerated behavior and excitable, shallow expression of emotions, use physical appearance to draw attention to self, sexually seductive, discomfort in situations where not the center of attention
