Psych Flashcards
clozaril SE’s
- weight gain/metabolic syndrome
- moderate risk of prolonged QTc
second generation antipsychotic least associated with weight gain
- Abilify
Second generation antipsychotics vs first generation antipsychotics
Less risk of EPS
EPS is
dystonia, akathisia, parkinsonism (dopamine deficiency)
Management of social anxiety disorder (social phobia)
- SSRI
- CBT
What is an adequate trial of an SSRI
6 weeks
Management of SSRI non responder
Stop SSRI, switch to another antidepressant
Management of patient who partially responds to an SSRI
Continue SSRI + Augment with a second agent
first line for borderline personality disorder
- psychotherapy (dialectical behavioral therapy)
Borderline personality disorder features
- unstable relationships
- mood instability (mood swings and mood reactivity)
- recurrent suicidal behaviors
- self mutilation and threats of self mutilation
- chronic feelings of emptiness
- transient paranoia
First line treatments for bipolar 1 disorder
- quetiapine
- lurasidone
- olanzapine + fluoxetine
- lithium
- lamictal
- valproate
Management of tardive dyskinesia
- discontinue causative medication if feasible
- *IF continued antipsychotic is required –> switch to second-generation antipsychotic
- treatment = valebnazine or deutetrabenazine
sporotrichosis clinical features + biopsy features
- nodule forms, which typically ulcerates or can remain nodular, then more proximal lesions develop in a lymphatic chain
- clear fluid drained
- no adenopathy or other signs of infection
- granulomatous inflammation
tularemia clinical features
- single erythematous ulcerative lesion with a central eschar + tender regional LAD
PFTs in primary pulmonary hypertension
- typically normal but decreased diffusion capacity
physical exam + clinical features of pulmonary HTN
- left parasternal lift, right ventricular heave
- loud P2, right-sided S3
- pan systolic murmur of TR
- **JVD, ascites, peripheral edema, hepatomegaly
Presentation + labs for APAP toxicity
- markedly elevated liver enzymes or acute liver failure
- may say concurrent intake of CYP450 meds (phenytoin or bactrim) or chronic alcoholic (additional RF)
- subtle at first (asymptomatic or mildly altered with nausea and vomiting, then become progressively lethargic)
Presentation + labs for liver abscess
- fever + RUQ pain
- elevated liver enzymes but not in thousands
acute hep c presentation
- often asymptomatic
- rarely causes liver failure
Management of SSRI withdrawal syndrome
- restart SSRI and then gradually taper
OR
substitute an equivalent dose of long-acting fluoxetine
Diagnosis of depression in cancer patients
- non somatic symptoms (loss of interest, worthlessness, suicidality)
- guilt over being a burden to family, thinking about death are not reliable because they are common among cancer patients
- Depression in cancer patients is under-recognized and underrated
Acute stress disorder presentation + feature differentiating it from PTSD
- within 4 weeks of a traumatic event (PTSD is over 1 month)
- similar to PTSD: re-experiencing of event + hyperarousal + avoidance behaviors + nightmares
Management of elderly male with depression
IF RF’s for suicide (widowed, living alone, hopelessness, access to firearms) –> psych hospitalization
Suicide risk from beta blockers
- association with depression hasn’t been supported by research
First and second line treatment of anorexia
First line: CBT + nutritional rehabilitation
Second line: olanzapine
Bulimia vs binge-eating disorder
- bulimia = inappropriate compensatory behavior
When pharmacotherapy is indicated for anorexia
- only when people don’t respond to nutritional rehab and psychotherapy
Postpartum depression vs blues
postpartum depression = 2 or more weeks + meeting SIGECAPS criteria
MMSE scoring + caveat
less than 24 = dementia
*highly educated patients can have normal scores
First line treatment of PTSD
- trauma focused CBT
- SSRIs or SNRIs
- not atypical antidepressants or wellbutrin
Treatment of akathisia
- Dose reduce antipsychotic if possible
- beta blockers or benzos
Indications for hospitalization with diverticulitis
- high fever or high white count
- poor oral intake
- significant comoborbidities
- immunosuppressed
Options for inpatient diverticulitis antibiotic treatmnet
zosyn
CTX + flagyl
quinolone + flagyl
Other features of PTSD
- dissociative symptoms (don’t confuse with depersonalization-derealization disorder)
antidepressants that don’t effect sexual function
- bupropion
- mirtazapine
Features of transient global amnesia vs. dissociative amnesia
- transient global amnesia = transient impaired anterograde memory (can’t form any new memories)
- dissociative amnesia = loss of autobiographical memory (no ability to remember details about self or family)
treatment of pelvic organ prolapse
- vaginal pessary
- pelvic floor muscle exercises
Panic disorder management
- acute: benzos
- maintenance: SSRI + CBT
