Psych Flashcards
SNRI
venlafaxine
duloxetine
desvenlafaxine
SNRI AE
anxiety and insomnia
TCA
doxepin
amitriptyline
TCA AE
increased QTc interval
buspirone AE
weaker, slower onset of action
do not use in anorexia or bulemia –> lowers seizure threshold
benzo AE
cognitive impairment
ataxia
withdrawal
abuse
GAD time criteria
> 6mo
panic disorder time criteria
3 panic attack episodes w/in 3wks
specific phobia time criteria
> 6mo
specific phobia tx
CBT w/ exposure therapy
social phobia time criteria
> 6mo
bipolar 1 criteria
manic at least 1wk
bipolar disorder 2 criteria
hypomanic, milder version of bipolar
4 days
lithium AE
check renal function (nephrotoxic)
nephrogenic DI, DMT2
hypothyroidism, tremor
Epstein’s anomoly (tricuspid valve abnormality)
if patient on lithium and pregnant, switch to
lamotrigine
valproate MOA and AE
increase GABA in brain
liver failure, pancreatitis
teratogenic neural tube defects
lamotrigine AE
SJS
carbamazepine AE
asplastic anemia
SIADH
teratogenic neural tube defect
bipolar tx
lithium
anticonvulsants: valproate, lamotrigine, carbamazepine
antipsychotics: quetiapine, lurasidone, olanzapine
benzo
quetiapine AE
increase mortality in elderly w/ demential related psychosis
suidical thoughts and behaviors
lursidone AE
increase mortality in elderly w/ demential related psychosis
suidical thoughts and behaviors
olanzapine AE
weight gain, DMT2
increase mortality in elderly w/ demential related psychosis
post injection delirium/sedation
strongest factor of bipolar disorder
FHx
depression screen
start in adolescents 12-18yo
cyclothymic disorder time criteria
at least 2y
not full hypomanic episode
MDD time criteria
> 5sx for at least 2wks
persistent depressive disorder (dysthymia) time criteria
at least 2yrs
PMDD time criteria
luteal phase
>5sx final week before menses
suicide risk factors
Sex male
Age (YA/elderly)
Depression
Previous attempt
Ethanol/drug use
Rational thinking loss (psychosis)
Sickness (medical illness)
Organized plan
No spouse or social support
Stated future intent
suicide highest RF
previous attempt
conduct disorder criteria
under 18yo
at least 3 behaviors over the past year and at least 1 occurring w/in past 6mo
oppositional defiant disorder criteria
at least 4 sx present > 6mo
oppositional defiant disorder tx
behavior mod
parent management training
rx if ADHD
Dissociative fugue
abrupt change in geographic location w/ inability to recall past, loss of identify
anorexia nervosa BMI
<17.5 or body weight <85% of ideal weight
anorexia nervosa labs
hyponatremia, hypokalemic
alkalosis if vomiting, arrhythmias (QT prolongation)
dec LH/FSH, dec estrogen/testosterone
hypothyroidism, hypoglycemia
osteopenia, anemia, inc BUN
anorexia indications for hospitalization
pulse <40, BP <80/60 or light headedness
orthostatic changes, hypothermia
refeeding syndrome
<70% expected weight or BMI <15
acute food refusal, suicidality, psychosis
refeeding syndrome sx
hypophosphatemia
dysrhythmia
severe edema
russels sign
bulimia
calluses on back of hands d/t induced vomiting
bulemia nervosa labs
hypochloremic
hypokalemic
metabolic alkalosis d/t vomiting
bulemia FDA approved tx
fluoxetine
binge eating disorder criteria
sx 1x/wk for 3mo
female sexual interest/arousal disorder criteria
3+ sx for 6mo that cause distress
impotence test
r/o med and rx causes
BIT: check for night time erections (postage stamp test)
if + night time erections = psych cause
tx impotence
PDE5 inhibitors (sildenafil)
vacuum device prosthetic
psychotherapy
paraphilia disorder criteria
sx for 6mo
OCD associated disorders
tourettes
tx w/ risperidone
ADD/ADHD criteria
at least 6 inattentive sx and/or at least 6 hyperactivity/impulsivity sx
sx present for >6mo in 2+ settings
onset usually <12yo
MC single genetic cause autism
fragile X syndrome
cluster A personality disorder
“weird”
schizoid
schizotypal
paranoid
cluster B personality disorder
“wild”
antisocial
borderline
histrionic
narcissistic
cluster C personality disorder
“wimpy”
avoidant
dependent
obsessive compulsive
brief psychotic disorder criteria
> 1 psychotic sx for <1mo
schizophrenia criteria
2+ sx present for at least 1mo
continuous impairment for >6mo
significant functional decline
tx schizophrenia
1st line: olanzapine, quetiapine, ziprazidone, risperidone
urine tox
refractory: clozapine
acute episode: hospitalization
schizophreniform criteria
schizophrenia for >1mo and <6mo
schizoaffective criteria
schizophrenia 2wks + mood disorder (MDD or manic)
delusional disorder criteria
1+ delusions for at least 1mo
function not significantly impaired
does not meet criteria for schizophrenia
cataplexy
loss of muscle tone following strong emotional stimulus
narcolepsy sx
excessive daytime sleepiness
hallucination just before sleep or just before awakening
sleep paralysis
narcolepsy test
polysomnography
narcolepsy tx
first line: modafinil
scheduled naps
restless leg disease test
polysomnography
nerve conduction studies
restless leg disease tx
lifestyle
D/C offending meds
supplemental iron
1st line: dopamine agonist: pramipexole, ropinerole
benzo as adjunct
gabapentin
somatic sx disorder criteria
1+ somatic sx (pain), distressing or resulting in significant disruption
no physical cause
>6mo
somatic sx tx
regular visits w/ 1 PCP
illness anxiety disorder sx and criteria
anxiety about health, hypochondriac
>6mo
illness anxiety disorder tx
regular visits w/ 1 PCP
factitious disorder sx
falsification of physical or psychological sx absence of obvious external rewards
repeated and long term hospitalization common
malingering vs factitious disorder
malingering: external reward or secondary gain. not a mental illness
factitious: no obvious external reward
alcohol use disorder tx
naltrexone: dec craving
acamprosate: for pts w/ liver dz or opioid use
disulfiram: 2nd line for highly motivated pts
thiamine, Mg (before dextrose), multivitamin, haloperidol if aggression
disulfiram CI
CV dz, DM, epilepsy, hypothyroidism, kidney problems
can cause N/V
alcohol withdrawal sx
6h
trembling, irritability
anxiety, HA, tachycardia
alcohol withdrawal tx
IV thiamine w/ mg (before dextrose)
multivitamin, folate
IV fluids
alcohol withdrawal seizure
48h, tonic clonic seizures
tx w/ benzo w/ taper (lorazepam)
head CT
delirium tremens
48-96h
autonomic instability, disorientation, hallucination, agitation
delirium tremens tx
thiamine –> glucose –> folate –> haloperidol (if psychosis)
opioids
morphine
heroin
methadone
oxycodone
codeine
opioids sx
pupil constriction (miosis)
euphoria and sedation
constipation, bradycardia, hypotension
respiratory depression, seizures, slurred speech
opioid intoxication tx
naloxone
opioid withdrawal sx
not fatal, anxiety, insomnia, anorexia, sweating
dilated pupils, piloerection
F, N/V, rhinorrhea, stomach cramps, diarrhea
flu-like sx
opioid withdrawal tx
methadone, buprenorphine + naloxone
naltrexone (block cravings)
clonidine, loperamide, NSAID
barbiturates sx
respiratory/CNS depression
depression, impaired memory, poor concentration
drowsiness
barbiturates tx
sx management b
barbiturates tx
sx management
barbiturates withdrawal
anxiety, seizures, delirium
tx: long acting Benz w/ taper or phenobarbital
benzo intoxication sx
amnesia, depression
ataxia, stupor, somnolence
minor respiratory depression
benzo intoxication tx
flumazenil
benzo withdrawal sx
rebound anxiety
seizures, tremor, insomnia
benzo withdrawal tx
long acting benzo w/ taper (clonazepam/diazepam)
amphetamines intoxication sx
AMS, euphoria, impaired judgement
delusion, hallucination, prolonged wakefulness/attention
agitaiton, pupil dilation, HTN, tachycardia, F, arrhythmia
violent behavior, psychosis, diaphoresis, choreiform movement, tooth decay
amphetamines tx
haloperidol, bezo, vitC
propranolol for rate control
MDMA (ecstacy) sx
hyperthermia, social closeness
“club drug”, hyponatremia
MDMA tx
CCB
do not give to MDMA intoxication
BB: cause coronary artery vasospasm
cocaine intoxication sx
AMS, euphoria, agitaiton, hallucination, paranoid ideations
dec appetite, tachycardia, pupil dilation, HTN
angina (MI/CVA)
repetitive motions
cocaine OD tx
haloperidol
benzo, vitC
labetalol
cocaine withdrawal sx
severe depression, hyperphagia, hyper somnolence, fatigue
malaise, severe psychological craving
cocaine withdrawal tx
bupropion, bromocriptine
SSRI for depression
wernickes encephalopathy
triad: ataxia, confusion, oculomotor palsy (d/t thiamine deficiency)
from chronic ethanol or benzo intoxication
Korsakoff syndrome
amnesia, hepatomegaly, palmar erythema
cirrhosis, dupuytrens contracture, gynecomastia
testicular atrophy
from chronic ethanol and benzo intox
PCP intoxication sx
belligerence, impulsiveness, fear, homicidality
psychosis, delirium, seizures
nystagmus, tachycardia, ataxia
PCP intoxication tx
benzos
haloperidol
PCP withdrawal sx
depression, anxiety, irritability, restlessness
anergia, thought/sleep disturbances
PCP withdrawal tx
sx tx
LSD intoxication sx
visual hallucinations, seeing sound as color
anxiety/depression, delusions
pupil dilation, “bad trip panic”
LSD intoxication tx
haloperidol
benzo
cannabis sx
slowed perception, conjunctival injection
increased appetite, dry mouth
cannabis withdrawal sx
peak in 48h, lasts 5-7d
irritability, depression, insomnia, N, anorexia, hyperemesis syndrome
inhalants intoxication sx
belligerence, assertive, impaired judgement
apathy, blurred vision, coma
inhalant intoxication tx
haloperidol
anticholinergic toxicity sx
Hot as a hare: inc body temp
dry as a bone: dec secretions
red as a beet: flushed skin
blind as a bat: cycloplegia, mydriasis
mad as a hatter: AMS
full as a flask: urinary retention, constipation
fast as a fiddle: tachycardia
adjustment disorder criteria
onset w/in 3mo
<6mo following termination of stressor
PTSD criteria
sx >1mo
acute stress disorder criteria
sx <1mo
PTSD tx
CBT, SSRI
prazosin to reduce nightmares
antipsychotics that have greatest risk of QTc prolongation
thioridazine
pimozide
droperidol
ziprasidone
clozapine AE
agranulocytosis
neuroleptic malignant syndorme sx
fever, confusion, muscle rigidity
rhabdo, autonomic instability (abn vitals, sweating)
neuroleptic malignant syndrome tx
stop meds, supportive
dantrolene or bromocriptine (if refractory)
tardive dyskinesia can be caused by
haloperidol
typical antipsychotic drugs (prolonged use)
acute dystonia caused by
haloperidol
typical antipsychotic drugs
acute dystonia sx
intermittent involuntary and uncoordinated hyperkinetic movements
spasm of tongue, neck, face, and back
sustained spasm
acute dystonia tx
IM/IV benztropine or diphenhydramine
serotonin syndrome sx
AMS, autonomic dysregulation (diaphoresis, tachycardia, HTN, hyperthermia),
neuromuscular hyperactivity (hyperreflexia, tremor, rigidity, babinski)
hyperactive bowel sounds, diarrhea
serotonin syndrome tx
d/c drugs, supportive
cyproheptadine for severe cases
sedation w/ benzos
meds that increase lithium levels
thiazide (HCTZ)
ACE (lisinopril)
NSAIDS
tetracyclines
metronidazole
neonatal abstinence syndrome
withdrawal from opiates due to maternal drug use
neuro: irritability, hypertonia, jittery, seizures
GI: diarrhea, vomiting, feed intolerance
autonomic: sweat, sneeze, pupil dilation
tx w/ opioid therapy (morphine, methadone)
normal grief
resolves w/in 1yr
abnormal grief
severe sx
>1yr continued sx
positive suicide ideation
persistent complex bereavement disorder
severe grief reaction >1yr (6mo in children) after death of bereaved
