Psyc Flashcards
2 benzo that can be used with alcohol withdrawl
lorazepam & oxazepam = safe on liver chlordiazepoxide = toxic to liver but can still be used
3 SSRI’s safe in kids?
Fluoxetine, Sertraline & Fluvoxamine
Acute dystonia Symptoms? Treatment? Prevention?
Involuntary muscle contraction or spasm, more likely in young men, occurs days to weeks after initiation of antipsychotics * treat with benztropine or diphenhydramine * to prevent can give a prophylactic benztropine w/ antipsychotic
Acute Stress Disorder vs Posttraumatic Stress Disorder(PTSD) duration?
ASD: occurs within 1 month and lasts <1 month of event PTSD: >1 month
Adjustment Disorder tx?
normal anxiety, depression, irritablity within 3 months of stressful event tx: psychotherapy
Alcohol intoxication sx
talkative, sullen(bad tempered/moody), gregarious, moody
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
Alcoholic Withdrawal Seizures time frame? tx? sx?
48hrs = tonic-clonic seizures tx: CT to R/O other cause
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!
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
Autism Spectrum Disorder sx? tx?
M > F; before 3 yoa, lack of peer relationships, odd preoccupation with repetitive activities tx: family counseling, special ed
Barbiturates and Benzos sx
inappropriate sexual or aggressive behavior, impaired memory or concentration
Binge Eating Disorder sx? tx?
sx: recurrent episodes of binge eating 3x per weeks for more than 3 months tx: TOPIRAMATE > SSRIs & CBT
Bipolar 1 VS Bipolar 2 VS Cyclothymia
Bipolar 1: Mania Bipolar 2: hypomania + depression Cyclothymia: hypomania + hypodepression
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
Bradykinesia(Parkinsonism) sx? tx?
weeks sx: bradykinesia, tremors, rigidity, sx of parkinsons tx: reduce dose of drugs or Anticholinergics(benztropine, diphenhydramine, Trihexyphenidyl)
Brief psychotic disorder
Psychosis lasting less than one month and onset often follows a psychosocial stressors
Cannabis sx?
impaired motor coordination, impaired time perception, social withdrawal, increased appetitie, dry mouth, tachycardia, conjunctival redness
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
Cluster A personality Disorders
Weird = Paranoid, Schizoid, Schizotypal
Cluster B Personality Disorders
Wild = Histrionic, Boarderline, Antisocial, Narcissistic
Cluster C Personality Disorders
Worried = Avoidant, Dependent, Obsessive-Compulsive
Compare: Anorexia Nervosa, Bulimia Neurvosa, Binge Eating Disorder, Body Dysmorphic Disorder
Anorexia: underweight, food restriction or excessive exercise, history of of purging or compensation Bulimia: normal weight, binge eating + guilt and some sort of compensation(vomiting, diuretics or enema use) Binge Eating Disorder: recurrent episodes of eating large quantities, feelings of lost of control during binge. Do not regularly have compensatory behaviors. Body Dysmorphic Disorder: pt is preoccupied with an imagined or slight defects in appearance with impaired ability to function in social or occupational settings.
Conduct vs Oppositional defiant disorder
Conduct: bullying, fighting, cruelty to people or animals, rape, vandalism Oppositional Defiant: typical teen anger, not present with friends
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.
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
Defense Mechanism: Regression
return to an earlier stage of dvelopment, most immature *9yo kid starts wetting his bed in response to parents divorce
Defense Mechanism: Splitting
“the morning staff is perfect, the evening staff is terrible”
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.
Defense Mechanism: Blocking
temporary block in thinking “i have known him for years but can never seeem to remember his name”
Defense Mechanism: Denial
used to avoid somthing painful “i know i do not have cancer”
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”
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”
Defense Mechanism: Introjection
“resident physician dresses like the attending whom he admires”
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”
Defense Mechanism: Projection
attributing your own wishes, thoughts, or feelings onto someone else ex: ‘im sure my wife is cheating on me”
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”
Defense Mechanism: Repression
an idea of feeling is withheld from conciousness; unconcious forgetting
Defense Mechanism: Somatization
psychic derivatives are converted into bodily symptoms. = thinkin of an exam makes you feel sick
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.
Defense Mechanism: Suppression
conscious forgetting; only consciouse defense mechanism “i would rather talk about my operation after the party is over”
Delirium Tremens sx?
occurs 48-96hrs after last drink(2 days) Delirium Tremens = hallucinations, diorientations, tachycardia, HTN, low-grade fever, agitation and Diaphoresis.
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!
Delusional disorder
Non-bizarre delusions for one month or more in the absence of other psychotic symptoms, often chronic, typically will respond poorly to antipsychotics
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
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
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)
Description of a child with Rett syndrome?
Excellent genetic disorder that affects only girls, normal child development up until the age of 6 to 18 months with arrest or rapid deterioration of mental, language, motor skills. Progressive macrocephaly and purposeless/stereotyped movement of hands. Epilepsy is common
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
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.
Dissociative Identity Disorder
Dissociative Identity Disorder = marked discontinuity in identity & loss of personal agency with fragmentation into >2 personality states. - Aka split personality disorder
Dyskinesia Symptoms? Treatment?
Parkinsonian him, shuffling gait, cogwheel rigidity, bradykinesia, onset is usually within weeks of initial therapy with antipsychotic * treat with anti-cholinergic such as benztropine or dopamine agonist such as amantadine
Dysthymia
Persistent depressive disorder = hypodepression lasting most days for at least 2 years
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
ethnic group with the highest rates of suicide?
Native Americans
Exhibitionism
recurrent urge to expose onself to strangers *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
Factitious Disorder VS Malingering Disorder
Factitious = wants to be patient Malingering = wants $$$
Fetishism
use of nonliving objects usually associated with the human body *must be more than 6months of sexual arousing w/impairment of functioning
Gender Dysphoria(Formerly Gender Identity Disorder)
persistent discomfort and sense of inappropriateness regarding patients assigned sex tx: psychotherapy & reassignment surgery
Genetic mutation associated with fragile X syndrome? Other characteristics of a child with fragile X syndrome?
CGG repeat, macro-orchidism, large body size, long face and intellectual disability
Gentiopelvic Pain disorder/dyspareunia
pain with sexual intercourse not due to medical condition tx: psychotherapy
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
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
How do you treat a psychotic break? when do you start long term psyc meds?
- hospitalize if needed 2. benzos for agitation & antipsychotics for 6 months *start long term therapy if there are repeat episodes
How does Zolpidem effect sleep late and and sleep time?
Decrease his sleep latency and increase his total sleep time, rapid onset and habit-forming which can lead to problematic or dangerous sleeping behavior such as sleep driving or sleep eating
how long for alcohol withdrawal?
5-10days
How long is a patient with MDD on antidepressants?
6 months then try to take them off. only need long term with multiple episodes
Hypnogogic & Hypnopompic hallucinations
hallucinations that occur as patient is going to sleep or as they wake up
Illness anxiety disorder
person isnt sick but is freaking the fuck about baout becomming sick ~AT LEAST 6 MONTHS
Indications for Elecctroconvulsive Therapy(ECT)
- MDD nonresponsive to medications - high risk for immediate suicide - C/I to using antidepressants - good response to ECT in the past
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
Main difference between a tick disorder and Tourette’s syndrome?
Tick disorder’s will be either motor or auditory. Whereas Tourette’s syndrome will have multiple motor and vocal tics present for greater than a year resulting in functional impairment. Tourette’s syndrome is often associated with ADHD and OCD
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
Malingering Disoder
person fakes sick knowningly to get $$$$$
Masochism
recurrent urge or behavior involving the act of humiliation or pain *must be more than 6months of sexual arousing w/impairment of functioning
MC method of suicide by both men and women?
firearms
MC method of suicide by women?
pills/poisons
MCC of death in Anorexia Nervosa?
arrhythmia
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
Minor Alcohol withdrawal time frame? tx? sx?
6hrs, Insomnia, tremulousness, mild anxiety, HA, diaphoresis, palpitations tx: B1, Folate, Multivitamin and Glucose
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
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
narcolepsy tx?
scheduled naps, Modafinil +- methylphenidate and dextraamphetamine
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
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
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.
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.
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
Opiates sx
apathy, dysphoria, CONSTRICTED PUPILS,drowsiness, slurred speech, impaired memory, coma, death
Order the benzos from shortest to longest half life: lorazepam, diazepam & alprazolam
shortest: Alprazolam(xanax) < Lorazepam(Ativan) < Diazepam(Valium) :longest
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
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
PCP sx
panic reactions, assaultiveness, agitation, NYSTAGMUS, HTN, seizures, coma, hyperacusis
Pedophilia
recurrent urges or arousal toward prepubescent children *must be more than 6months of sexual arousing w/impairment of functioning
Penetration Disorder
involentary constriction of outter 3rd of vagina causing pain on penitration tx: psycotherapy & dilator therapy
Postpartum Blues/Baby Blues VS Postpartum Depression VS Postpartum Psychosis
Postpartum Blues/Baby Blues = cares about baby, mild depression, self limited Postpartum Depression = +/- thoughts of hurting baby, severe depression, needs antidepressants Postpartum Psychosis = most have thoughts of hurting baby, psychotic symptoms along with severe depression, needs antidepressants and mood stabilizers.
Postpartum psychosis
Psychiatric emergency due to increased risk of infanticide. More common in mothers with bipolar disorder, treat with lithium and antipsychotics
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
Premature Ejaculation
ejaculation just before or just after penitration tx: stop & go, Squeeze technique, SSRIs
Pt has depression + Neuropathic pain. best drug? class?
SNRI = Duloxetine
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
Ramelteon use? C/I?
mimics melatonin = good for pt who need help falling asleep C/I: hepatic impairment, severe sleep apnea, severe COPD
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
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
Schizoid Personality Disorder
detachment and restricted emotionality = emotionally distant & fear intimacy, absorbed with their own thoughts and feelings and disinterested *main defense is projection
Schizophreniform disorder
Symptoms of schizophrenia lasting between one and six months
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
Schizotypal personality disorder versus schizoaffective disorder
*Schizotypal personality disorder is a predominantly mood disorder with psychotic features- magical thinking * schizoaffective disorder is a predominantly psychotic disorder with a mood disorder on top of it. Patient needs to have at least two weeks without a mood episode.
Seasonal affective disorder
depression in winder months = phototherapy or sleep deprivation
Serotonin Syndrome
hx of SSRI, agitation, hyperreflexia, hyperthermia, Mrigidity, volume contraction secondary to sweating an dinsensible fluid loss tx: ciproheptadine, benzo
Severe Intellectual Disability & Pround ID IQ? features?
Severe: IQ 20-35 Profound: <20 Cant live on their own, need full time help
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
Side effect profile for Thioridazine
prolonged QT and arrhythmias, abnormal retinal pigmentation
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
side fx clozapine
agranulocytosis = reserved for tx resistant shit
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
Sleep paralysis
patient is awake but unable to move; this typically occurs upon awakening
Stages/Timeline of Alcohol withdrawal
6 hrs: Minor Withdrawal = insomia, tremulousness, HA, palpitations, diaphoresis *give thiamine, folate, vitammin, glucose 12-24hrs: Alcoholic hallucinosis = visual hallucinations 48 hr: Withdrawal Seizures 48-86hr: Delirium Tremens = hallucinations, diorientations, tachycardia, HTN, low-grade fever, agitation and Diaphoresis.
Suicide Protective Factors
connection to family, pregnancy, responsibility for children, religious affiliation
Suicide Risk Factors
men, older adults, social isolation, presence of psychiatric illness/drug abuse, percieved hopelessness, previous attempts
Symptoms of Major Depressive Disorder(MDD)?
SIGECAPS: Sleep changes Interest loss Guilt Energy decrease Concentration difficulty Appetite changes Psychomotor activity changes Suicidal thoughts
Tardive dyskinesia Symptoms? Treatment?
Stereotypic oral facial movements, likely from dopamine receptors sensitization, often Irreversible, generally occurs after long-term use of antipsychotic medication * discontinue or decrease the dose of antipsychotic or switch to a second generation/atypical antipsychotic ** giving an anticholinergic, decreasing antipsychotic may initially worsen tired of dyskinesia
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
timeline: schizophrenia, schizophreniform, brief psychotic disorder
phrenia = >6m phreniform = 1-6m brief psychotic disorder = <1m
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
Treatment for bipolar disorder?
1st line: Lithium, Lamotrigine or Risperidone 2nd line: aripiprazole, divalproex, quetiapine, olanzapine + CBT and psychotherapy
True or false diphenhydramine can be used to treat EPS
True
Tx of ASA toxicity?
Na Bicarb! = want alkalosis to prevent protonation which is what allows salicylate’s to cross into BBB & cause damage
tx of barb/benzo intoxication
Flumazenil
tx of cocaine/amphetamines withdrawl
bupropion and/or bromocriptine
tx of opiate intoxication
naloxone
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
what are negative symptoms of schizophrenia?
flattened affect, social withdrawal, anhedonia, apathy, poverty of thought
What are positive symptoms of schizophrenia?
delusions, disorganized speech, hallucinations
What do you give to treat TCA toxicity? Why?
Sodium bicarbonate – alkalize the blood to about 7.5 this will prevent TCA from binding cardiac muscles = prevents arrhythmias
What is a brief psychotic disorder?
psychotic symptoms present for <1m
What is Acute Dystonia? timing treatment?
TIMING: first few weeks SX: muscle spasms, difficulty swallowing TX: reduce the dose, give anticholinergics(benztropine, diphenhydramine, trihexyphenidyl)
What is Adjustment Disorder?
anxiety, depression, irritability that occurs soon after profound changes in a persons life. Occurs within 3 months of a stressful event.
What is Agoraphobia?
fear of avoidance of places due to anxiety about NOT BEING ABLE TO ESCAPE.
What is Akathisia? timing? treatment?
TIMING: weeks - chonic use SX: motor restlessness. *DO NOT MISTAKE FOR ANXIETY TX: reduce the dose, Benzodiazepines or BB, switch to newer antipsychotic
What is Antisocial PD?
antisocial or criminal acts, inability to conform to social rules, impulsivity, disregard for the rights of others, aggressiveness, lack of remorse and deceitfulness
What is Avoidant PD?
individuals have social inhibition, feelings of inadequacy and hypersensitivity to criticism. They shy away from starting anything new or attending social gatherings in fear of failure or rejection. they desire affection and acceptance and are open about their isolated and inability to interact with others.
What is Borderline PD?
unstable affect, mood swings, marked impulsivity, unstable relationships, recurrent suicidal behaviors, chronic feelings of emptiness, identity disturbances, and inappropriate anger. *defense mechanism is usually splitting
What is Bradykinesia? timing? treatment?
TIMING: weeks SX: bradykinesia, tremors, rigidity and other signs of parkinsons TX: reduce the dose, anticholinergics(benztropine, diphenhydramine, trihexyphenidyl)
What is Conversion Disorder?
one or more NEUROLOGIC symptoms that cannot be explained by any medical or neurological disorder. *usually mutism, blindness, paralysis and anethesia/paresthesia. **pt are usually not concerned about the deficit
What is Delusional Disorder?
person suffers from delusions but minimal to no hallucinations or bizarre behaviour. there is no impairment of baseline functioning.
What is Dependent PD?
submissive and clinging behavior related to a need to be taken care of. clingy and worry about abandonment. they feel inadequate and helpless and avoid disagreements with others. they usually focus on dependency on a family member or spouse.
What is Disruptive Mood Dysregulation Disorder?
child with a pervasively angry or irritable mood, with frequent outburst that are out of proportion to the stresses. PATIENTS DO NOT RETURN TO A NORMAL MOODS after outburst. They are just pissy.
What is Exhibitionism?
recurrent urge to expose oneself to strangers
What is Frotteurism?
Recurrent urge or behavior involving touching or rubbing against a non-consenting partner
What is Generalized Anxiety Disorder(GAD)? Tx?
Excess anxiety that occurs daily for more than 6 months. no single focus or event. often coexists with other shit(MDD, specific phobia, social phobia, panic disorder). tx: CBT, SSRI, Benzo, vanlafaxine, buspirone
What is Histrionic PD?
colorful, exaggerated behavior and excitable, shallow expression of emotions. use of physical appearance to draw attention to self. sexually seductive, discomfort in situations where not the center of attention.
What is Illness Anxiety Disorder(IAD)?
pt experiences anxiety about having a illness for at least 6 months
What is Intermittent Explosive Disorder? tx?
Episodes of aggression out of proportion to the stressor +/- history of head trauma. Only dx in AGE 6+. with episodes 2x a week for 3 months or destructive episodes 3x within a 12 month period. tx: SSRI & mood stablizers
What is Kelptomania?
pt who repeatedly steals items to relieve anxiety
What is Narcissistic PD?
Characterized by a sense of self-importance, grandiosity, preoccupation with fantasies of success. Person believes he is special, requires excessive admiration, reacts wit rage when criticized, lacks empathy, is envious of others, and is interpersonal exploitative.
What is Neuroleptic Malignant Syndrome? timing? treatment?
TIMING: anytime SX: muscle rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC, increased CK TX: stop drugs, transfer to ICU, dantrolene.
What is Obsessive-Compulsive Disorder(OCD)? Tx?
recurrent obsessions and compulsions. Individual recognizes behavior is unreasonable and excess. Often coexist with depression and substance abuse. **DO NOT HAVE HALLUCINATIONS Tx: behavioral therapy, SSRI and Clomipramine.
What is Obsessive-Compulsive PD?
individuals are preoccupied with orderliness, perfections and control. They are often consumed by the details of everything and lose their sense of overall goals.
What is Panic Disorder? Tx?
brief attacks of intense anxiety with autonomic symptoms( tachycardia, hyperventilation, dizziness and sweating), episodes occur regularly. TX: CBT, relaxation, desensitization, SSRIs and Benzos
What is Paranoid PD?
distrust suspiciousness, individuals are mistrustful and suspicious of the motivations and actions of others are are often secretive and isolated. they are emotionally cold and odd. they often take legal action against other ppl. *main defense is projection.
What is Persistent Depressive Disorder(Dysthymia)? tx?
Low level depression symptoms that are present on most days for at least 2 years tx: long term individual, insight oriented psychotherapy. SSRIs
What is Schizoaffective Disorders?
Symptoms of schizophrenia and a mood disorder
What is Schizoid PD?
detachment and restricted emotionally. Emotionally distant and fear intimacy with others, absorbed in their own thoughts and feelings and disinterested
What is Schizophrenia?
positive and negative psychotic symptoms lasting for >6m
What is Schizophreniform Disorder?
symptoms of schizophrena lasting between 1-6months
What is Schizotypal PD?
Discomfort with socal relationships, thought distortion, eccentricity. similar to schizoid but with magical thinking, clairvoyance, ideas of reference, or paranoid ideation.
What is Seasonal Affective Disorder? tx?
depressive symptoms in the winter months tx: phototherapy or sleep deprivation
What is Tardive Dyskinesia? timing? treatment?
TIMING: months - years SX: choreoathetosis and other involuntary movements after chronic use, often irreversible TX: Stop older antipsyc, switch to newer drugs, give valbenazine or benztropine *sx often worsen after medication change
What is Tardive Dyskinesia? tx?
choreoathetosis that occurs over months to years of use with use of antipsychotics(D antag). Tx: denztropine or Valbenazine
What is the mechanism of action of Disulfiram?
Disulfiram inhibits the enzyme acetaldehyde dehydrogenase leading to an increase in acetaldehyde when alcohol is consumed. Acetaldehyde causes NV, HA, tachycardia and sweating
What is Voyeurism?
Recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing. This is the earliest paraphilia to develop.
What medications can be used to treat irritability and aggression in individuals with autism spectrum disorder?
Antipsychotic such as risperidone or aripiprazole
What other two disorders is Tourette’s syndrome often associated with
ADHD and OCD
What should you do with a patient who is on lithium and currently stable who develops hypothyroidism?
Continue on their same dose of lithium and start Synthroid
Which 2nd gen antipsyc has least risk of tardive dyskinesia
clozapine
Which antihypertensive medications are the safest to use in a patient who is taking lithium?
Calcium channel blocker‘s! Any medication that affects GFR or sodium/potassium levels will also affect lithium levels. Therefore calcium channel blocker‘s tend to be the safest in these patients
which antipsyc can cause QT prolongation
thioridazine & ziprasidone
which antipsychotic is safe in prego?
LURASIDONE
which atypical antipsyc has the least risk of DM & weight gain? which has the most?
most = olanzapine least = aripiprazole
Which mood stabalizer can cause alopecia
valproate
which SSRI can you NOT use in prego?
paroxetine
You suspect a psychotic disorder or some sort. What tests do you need to order/run before you go jumping to dx something psyc?
TSH(hypo/hyperthyroidism), Electrolytes, Ca, HIV serology, VDRL, Drug screen, r/o temporal lobe epilepsy
You suspect pt has MDD? what are other causes of depression you should check for before making the dx?
Hypothyroidism, Parkinsons Disease, Medications( BB, antipsyc, steroids), Alcohol, amphetamines
You suspect the patient may have an anxiety disorder. What are some other causes of anxiety you should consider before dx.
Medical: hyperthyroidism, pheochromocytoma, excess cortisol, heart failure, arrhythmias, asthma, COPD Drugs: corticosteroids, cocaine, amphetamines, and caffeine, withdrawal from alcohol and sedatives.
