Psych Flashcards
What are risk factors for suicide?
- Older adult who has recently lost a spouse
- plan involving a gun or lethal weapon
- history of attempted suicide or family hx of suicide
- mental illness
- history of abuse
- terminal illness or chronic pain
- ETOH/Drug abuse
- Age 15-24 years and >60
Who is at highest risk of suicide according to LEIK
-elderly males who recently lost a partner
The hunter toxicity criteria decision rules state regarding Serotonin toxicity the patient must
have taken a serotonergic agent and meet 1 of the following criteria
- spontaneous clonus
- inducable clonus + agitation and diaphoresis
- ocular clonus + agitation and diaphoresis
- tremor + hyperreflexia
- hypertonia + temperatur >100.4
Higher risk of serotonin syndrome occurs when
combining 2 or more drugs that block serotonin
What is malignant neuroleptic syndrome
- A rare life threatening idopathic reaction from typical or atypical antipsychotic
- Can also be seen in parkinsons with removal or reduction in L-dopa or dopamine agoinist therapy
What are sx of malignant neuroleptic syndrome
- high fever
- muscle rigidity
- mental status change
- dysautonomia (fluctuating BP and urinary incontinence)
A questionnaire used to evaluate an individual for confusion and dementia
-Folstein MMSE
Orientation is tested by asking questions like
What day it is
What location the patient is in
Immediate recall is assessed by
instructing patient that you will be testing their memory ; say 3 unrelated words and ask the patient to repeat
Attention and calculation is assessed by
serial 7’s
spell a word backward
Writing and copying
-as a patient to copy a figure or write sentence
What is the max score of an MMSE
30
A score of ___ on the MMSE indicates impairment
19 or less
What are the adverse effects of atypical antipsychotics and therefore what should you monitor
- obesity and T2DM
- All can cause weight gain so assess BMI/weight every 3 months
SSRIs are first line for what conditions
- depression
- OCD
- GAD
- Panic
- social anxiety
- Premenstrual dysphoric disorder
- PTSD
What are the adverse effects of typical antipsychotics
and what do you need to monitor
- elevates triglyceride/lipids
- extrapyramidal side effects
- tardive dyskinesia
- QT prolongation
- sudden death
- Malignant neuroleptic syndrome
labs: blood glucose and lipid profiles
What are adverse effects of anticonvulsants and what needs to be monitored
- AE: Steven-Johnson Syndrome
- Must monitor: Serum concentrations in valproic acid and carbamezapine
What is an AE of Bupropion and when is it contraindicated
- seizures
- CI: seizure disorder, anorexia, bulimia
What mental health medications can precipitate acute narrow angle glaucoma
-venlafaxine and duloxetine
What mental health medications can have anticholinergics side effects
-TCAs
What SSRI has the longest 1/2 life
Prozac (Fluoxetine)
What SSRI has the shortest 1/2 life
Paxil (Paroxetine)
What SSRI has the least drug interactions
Celexa
MAOIs are rarely used due to _____
serious food (high tyramine content) and drug interactions
What are examples of high tyramine foods
-beer, wine aged cheese, fava beans
Abrupt discontinuation of benzodiazepines can increase risk of
seizure
Symptoms of Depression
SIGECAPS
- Sleep: Insomnia or hypersomnia
- Interest: Reduced, loss of pleasure
- Guilt: Feelings of worthlessness
- Energy: Fatigued or loss of energy
- Concentration: Diminshed
- Appetite changes
- Psychomotor retardation
- Suicidal ideations
What lab tests should you order in a patient presenting with sx of depression
- CBC
- Chem profile
- TSH
- Folate and Vit B12
- US
It may take ____ to achieve antidepressant effects from SSRIs
4-8 weeks
You must continue SSRI therapy for at least ___ months post initiation
4-9 months
What are extrapyramidal side effects
- Akinesia: inability to initiate movement
- Akathsia: inability to stay still
- bradykinesia: slow movement
- tardive dyskinesia: involuntary movements of the lops, tongue, face, and extremities
What are the side effects of anticholinergics SAD CUB
- Sedation
- Anorexia
- Dry Mouth
- Confusion and Constipation
- Urinary Retention
- BPH
What is the difference between major and minor depression
-minor depression is a milder form; the criteria is the same as major depression except there are fewer symptoms (at least 2 but less than 5)
Antipsychotic medications increase risk for
obesity, T2DM, hyperlipidmia, metabolic syndrome, hypothyroid
The FDA has a black box warning for SSRIs that includes
Increased risk of suicidal thinking and behaviour in younger adults in the first 2 months of treatment
What is a standard drink sizes
- beer 12oz
- malt liquor 8-9oz
- wine 5oz
- liquor/spirits 1.5oz
What are recommended drink guidelines
- women: 1 drink/day
- men: 2 drinks/day
What is considered binge drinking?
- males: 5+ drinks in a single occasions
- females: 4+ drinks in a single occasion
what is korsakoff’s syndrome
- a complication from chronic alcohol abuse
- caused by chronic thiamine deficiency
- a neurologic disorder with sx that include hypotension, visual impairment and coma
What are sx of korsakoff’s syndrome
- mental confusion
- ataxia
- stupor
- coma
- hypotension
What are risk factors for insomnia
- depression
- anxiety
- GERD
- female gender
- Illicit drug use
- MSK illness
- pain
- chronic health problems
- shift work
- ETOH
- Caffeine
- Nicotine
- certain meds
What is the 1st line treatment for insomnia
-sleep hygiene: maintain regular sleep, nighttime rituals, avoid caffeine, tobacco/heavy meals before bed, use bed only for sleep and sex, avoid media
The gold standard to dx sleep apnea is
Polysomnography
A lone ___ can be a sign of occult ETOH abuse
GGT
AST/ALT ratio of ___ of higher is likely alcoholism
2
These natural supplements are used for insomnia and anxiety. You cannot mix them with benzos, hypnotics or CNS depressants
Kava-Kava
Valerian root
Bipolar disorder presentation
- mood instability
- alternating cycles of mania and depression
- manic episodes are increased energy/activity, grandiosity, less need for sleep, disinhibition, talkative, euphoric mood
What is the management of bipolar disorder
- Lithium
- Anticonvulsants
- Second generation antipsychotics
Antipsychotics require the following lab tests
- A1C
- Lipids
- EKG
Antipsychotics can _____ the QT interval and cause
prolong QT interval and cause torsade de points
What is the presentation of anorexia nervosa
- intense fear of gaining weight along with distortion of body shape and weight
- severe food intake
- BMI <18.5
- lanugo
- amenorrhea for 3 mths or longer
What are complications of anorexia
- osteopenia/osteoporosis
- peripheral edema r/t low albumin
- cardiac complication (arrhythmias, cardiomyopathy, atrophy of cardiac muscles, bradycardia)
- Hypotension
What is motivational intereviewing
-a counselling method used to help an individual resolve a state of indecision into finding the internal motivation to make positive healthier behaviors
The most common psychiatric disorder is
Depression
It can take ___ to see improvement in depression symptoms and ___ for releif
2-4 weeks; 6-12 weeks
Bipolar ___ is more common that Bipolar ___
2; 1
