psych Flashcards
?? is a serotonin-norepinephrine reuptake inhibitor that can cause dose-dependent hypertension. Blood pressure should be monitored regularly, especially at higher doses
Venlafaxine
This child’s history of early foster care placement due to parental substance use, social withdrawal, lack of positive response to attempts to comfort, and poor emotional responsiveness is consistent with ??
reactive attachment disorder (RAD)
Bipolar disorder is a highly recurrent illness. how long is pharm therapy indicated?
Maintenance treatment is recommended to decrease the risk of recurrent manic or depressive episodes. Lithium therapy should be maintained in patients whose condition is stable and who are tolerating the medication.
Long-standing diabetes mellitus (especially type 1) is a common cause of ???. Patients typically have postprandial vomiting, early satiety, weight loss, and abdominal pain, and many develop food aversion.
gastroparesis
best diagnosis for gastroparesis
The diagnosis is best evaluated with a gastric-emptying scan and an investigation for mechanical obstruction (eg, upper endoscopy ± CT/MR enterography).
Active substance use, including alcohol and prescription and/or illicit drugs, is associated with disinhibition and an increased risk of ??.
suicide
Patients who do not respond to selective serotonin reuptake inhibitors may benefit from switching to another first-line antidepressant medication. The norepinephrine and dopamine reuptake inhibitor ??? is an activating antidepressant with a favorable side effect profile (eg, no weight gain or sexual side effects), making it a good choice for patients with weight gain, hypersomnia, or sexual dysfunction.
bupropion
When a patient’s family members are reluctant to withdraw care, ??? orders can promote agreement with the care team, minimize futility, and lessen feelings of guilt for hastening the patient’s death.
No Escalation of Treatment (NEOT) orders are predetermined limits of care that are not to be exceeded regardless of clinical status.
?? is the medication of choice for treatment-resistant schizophrenia and should be considered in patients who have failed ≥2 antipsychotic drug trials.
Clozapine
Clozapine is the medication of choice for treatment-resistant schizophrenia and should be considered in patients who have failed ≥??? antipsychotic drug trials.
2
This patient’s depression and sleep disturbances, in the context of centralized obesity, proximal muscle weakness, a ruddy appearance, hypertension, hypokalemia, and hyperglycemia, are suggestive of ??
Cushing syndrome
Neuropsychiatric manifestations of Cushing syndrome include depressed or labile mood, anxiety, irritability, insomnia, memory deficits, and fatigue.
what to do with an agressive patient in the ED?
interview patient with the door open and security personel nearby
Antipsychotic medication nonadherence is a common cause of relapse and rehospitalization in patients with schizophrenia. ??? antipsychotics are useful for patients who have responded to oral antipsychotics but relapse frequently due to medication nonadherence.
Long-acting injectable
patient’s symptoms of insomnia and impaired concentration, developing within 3 months of an identifiable stressor (eg, job loss, moving back in with his parents), are consistent with an ??
adjustment disorder
Binge eating disorder is characterized by repeated episodes of excessive eating accompanied by a loss of control and subsequent distress. The most effective treatment is psychotherapy. Medication options include (3)
Options include selective serotonin reuptake inhibitors such as sertraline, the stimulant lisdexamfetamine, and the antiepileptic agent topiramate.
??? is a circadian rhythm disorder characterized by the inability to fall asleep at traditional bedtimes, resulting in sleep-onset insomnia and excessive daytime sleepiness. Patients sleep normally if allowed to follow their internal circadian rhythm and sleep until late morning.
Delayed sleep-wake phase disorder
Stimulant misuse should be considered in patients with psychomotor agitation and signs of sympathetic hyperactivity. ?? are the treatment of choice
Benzodiazepines
??? therapy is an effective adjunct to antipsychotic medication in patients with schizophrenia and has been shown to reduce the risk of relapse.
Family therapy
It focuses on educating the family about the symptoms, course, and treatment of the disorder, and it helps to promote a supportive family environment.
bupropion is contraindicated with history of bulimia nervosa; the risk of ??? increases in patients with active or historical bulimia or anorexia nervosa because of potential electrolyte disturbances
seizures
Acute dystonia is a type of extrapyramidal symptom associated with antipsychotic treatment. It is most commonly seen with high-potency first-generation antipsychotics and is best treated with which two drugs??
anticholinergics (benztropine) or antihistamines (diphenhydramine).
What is most helpful in the early detection of prescription opioid misuse in patients?
The prescription drug monitoring program records prescribed controlled substances that the patient received, including quantities, dates the prescriptions were filled, and prescriber information. This database can identify patients who are obtaining opioids from multiple prescribers, thereby raising concern for overuse or diversion.
which antipsychotic agent can cause QT-interval prolongation; therefore, an ECG should be obtained prior to administering these agents to avoid causing a life-threatening arrhythmia (ie, torsade de pointes)
haloperidol
other antipsych meds do too
The antipsychotic clozapine is associated with an increased risk of ???
seizure
Major depressive disorder is frequently recurrent. Long-term maintenance antidepressant therapy is indicated for patients with ≥?? major depressive episodes
2
First-line treatment of PTSD includes ??? and/or pharmacotherapy with a serotonergic antidepressant (selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor)
trauma-focused cognitive-behavioral therapy (CBT)
?? a rare but potentially lethal adverse reaction to antipsychotic medications (neuroleptics). Its cardinal features include severe hyperthermia, autonomic dysregulation, lead-pipe rigidity, and altered mental status
neuroleptic malignant syndrome (NMS)
Treatment of neuroleptic malignant syndrome (NMS) includes the following:
Prompt discontinuation of the offending agent (the antipsychotic)
Supportive care (ie, aggressive cooling, intravenous fluids, and electrolyte repletion).
which three medications???
Benzodiazepines, which can improve agitation and decrease muscle contraction
Bromocriptine or amantadine, dopaminergic medications that can be considered in a patient whose condition does not respond to supportive care and withdrawal of medication.
Dantrolene, a direct-acting muscle relaxant with a rapid onset of action that can reduce heat production and muscle rigidity.
Patients with body dysmorphic disorder typically have limited insight into their condition and therefore require a sensitive and tactful assessment approach. The physician should acknowledge their distress and avoid referring to perceived defects as “imagined” or arguing with them about their appearance. Physicians should empathize with patients’ efforts to cope with their condition and determine their level of insight by ??
exploring their perceptions of how others see them.
what is the management of postpartum psychosis
Postpartum psychosis is a medical emergency characterized by delusions, hallucinations, and disorganized thoughts or behavior often accompanied by mood symptoms. Due to the high risk for suicide/infanticide, most patients require hospitalization to ensure safety.
Psychosis is common in Parkinson disease, occurring at a higher rate in those treated with dopamine agonists than in those treated with carbidopa-levodopa. Psychotic symptoms can be treated with antiparkinson medication dose reduction and/or the addition of a low-potency antipsychotic such as ??
quetiapine, clozapine, or pimavanserin
?? involves recurrent binge eating and compensatory behaviors
Bulimia nervosa
no compensatory behavior would be binge eating disorder
acute stress disorder vs. PTSD
ASD < 1 month > PTSD
This patient has subjective shortness of breath with good oxygenation, clear lungs, and a deep breathing pattern punctuated by audible sighs. In addition, she has paresthesias of her hands that presented during a time of significant stress. This is consistent with ??
hyperventilation syndrome
Initial treatment is reassurance with breathing retraining
associated signs and symptoms of this disease include constipation, cold intolerance, bradycardia, hypotension, which are important diagnostic clues because patients want to hide condition
Anorexia nervosa (AN)
The acute onset of headache following a meal in a patient treated with phenelzine raises concern for ??
hypertensive crisis
Patients taking monoamine oxidase inhibitors such as phenelzine should avoid foods rich in tyramine as the interaction of such food-drug combinations can result in hypertensive crisis.
Tardive dyskinesia occurs after prolonged exposure to antipsychotic drugs and is characterized by abnormal involuntary movements of the mouth, tongue, face, trunk, or extremities. When antipsychotic dose reduction or discontinuation is not feasible, using valbenazine or deutetrabenazine or switching to ??? should be considered.
clozapine
Tardive dyskinesia occurs after prolonged exposure to antipsychotic drugs and is characterized by abnormal involuntary movements of the mouth, tongue, face, trunk, or extremities. When antipsychotic dose reduction or discontinuation is not feasible, using ?? or switching to clozapine should be considered.
valbenazine or deutetrabenazine
vesicular monoamine transporter Type 2 (VMAT-2) transports serotonin, norepinephrine, and dopamine for storage and future neurotransmission, the inhibition of VMAT-2 increases cytosolic dopamine levels and decreases synaptic dopamine release and post-synaptic receptor stimulation, thereby decreasing dyskinesia
Patients with panic attacks frequently develop ???, which is anxiety and avoidance of ≥2 situations in which it may be difficult to escape or get help (eg, being outside the home or in enclosed spaces, using transportation) in the event of a panic attack.
agoraphobia
??? is first-line treatment for major depressive disorder with psychotic features. It is particularly appropriate for severely depressed patients who refuse to eat and drink or are acutely suicidal.
Electroconvulsive therapy
Patients with bipolar II disorder experience at least 1 episode of hypomania and ≥1 major depressive episodes. First-line treatment of bipolar depressive episodes includes which two antipsychotics???
lurasidone and quetiapine
Adjustment disorder involves symptoms causing marked distress and impairment that develop within ? months in response to a stressor.
3
?? is characterized by intrusive, recurrent, and persistent unwanted thoughts and repetitive behaviors or mental acts in response to the obsessions. Patients typically have prominent anxiety symptoms that must be differentiated from those of primary anxiety disorders.
Obsessive-compulsive disorder
Because of methadone’s long half-life, its effects, including respiratory depression, can recur for up to ?? hours following an acute overdose.
24-48
??? have amphetamine-like properties that can cause severe agitation, combativeness, psychosis, delirium, myoclonus, and, rarely, seizures. Tachycardia and increased blood pressure are often present. In contrast to other stimulants and hallucinogens, which have a much shorter duration of effect, the effects of intoxication may take up to a week to subside.
Synthetic cathinones (“bath salts”)
Treatment options for Tourette disorder include habit reversal training, and which two types of medication?
Antidopaminergic agents are the most effective medications and include the dopamine-depleting agent tetrabenazine as well as antipsychotic agents that act as dopamine-receptor blockers (eg, risperidone, haloperidol). Alpha-2 adrenergic agonists (eg, guanfacine, clonidine)
Low ??? in cerebrospinal fluid is associated with suicidal behavior.
5-hydroxyindoleacetic acid (5-HIAA) is a metabolite of serotonin.
Premature ejaculation is characterized by uncontrolled ejaculation and decreased ejaculatory latency. Most patients respond to which psych drug????, which prolong ejaculatory latency. Patients may also benefit from local anesthetics and/or psychotherapy to address concurrent anxiety, mood disorders, and relational issues.
selective serotonin reuptake inhibitors
This patient’s retrograde and antegrade amnesia with intact long-term memory, confabulation, apathy, lack of insight, and history of alcohol use disorder are most consistent with a diagnosis of ???
Korsakoff syndrome (KS)
