psych Flashcards
GAD diagnostic criteria
excessive worry, more often than not, for at least 6 months
not d/t substance or medical condition
3 of the following symptoms:
- edginess or restlessness
- tiring easily; fatigue common
- impaired concentration
- irritability
- muscle aches or soreness
- difficulty sleeping
SSRIs
- first line for GAD & depression
- increased suicide risk week 1
- 4-6 weeks for full effect
- can try different SSRIs if not responsive to one agent
- do not give with MAOI
- follow up in 1 week
- must taper off
- continue in hospital!
AEs: HA, sexual dysfunction, serotonin syndrome, GI upset, dizziness,
SNRIs
second line for GAD
venlafaxine (Effexor)
- 37.5 mg/day initially
- can titrate to 75 mg QD after 4-7 days
- increase in increments <75 mg q 4 days up to 225 mg/day
- may cause hypertension!!!
- do not give with MAOIs
AEs: same as SSRIs
rule out differentials for panic attack
pheochromocytoma
thyrotoxicosis
hypoglycemia
meds for panic disorder
SSRIs
SNRIs
MAOIs
BDZs
meds for GAD
SSRIs
SNRIs
TCAs
MAOIs
buspirone
benzos
clonidine
propranolol
TCAs
second line for GAD & depression
lethal in overdose
may have more side effects d/t antihistamine and anticholinergic properties
AE: sedation, constipation, blurred vision, dry mouth, QT prolongation
MAOIs
third line for depression
dietary restrictions - low tyramine diet (caviar, meats, cheeses)
can cause hypertensive crisis without dietary adherence
MDD treatment
SSRI, then ECT therapy
suicide risk factors
SADPERSONAS
sex - male
age - 25-65
depression
previous attempts
ethanol
rational thinking loss
social support loss
organized plan
no spouse
availability of lethal means
sickness
what to do w mood stabilizers in the hospital
continue!!!
check serum level and adjust dose if necessary
psych consult if not psychologically stable
lithium considerations
low therapeutic index
supra therapeutic ->kidney injury
mild intoxication - confusion, tremor, nystagmus
severe intoxication - N/V, agitation, seizures, bradycardia, hypotension
treat toxicity with fluids, GI decontamination, hemodialysis (severe neurological symptoms or lithium >4)
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schizophrenia positive symptoms
delusions, hallucinations, conceptual disorganizations
schizophrenia negative symptoms
anhedonia, loss of function, decreased emotional expression, impaired concentration, diminished social engagement
cornerstone of schizophrenia treatment
typical & atypical antipsychotics
antipsychotics adverse effects
QTc prolongation
weight gain
hyperglycemia
hyperlipidemia
impaired temp regulation
water intoxication
clozapine (clozaril) - agranulocytosis leading to seizures - check weekly WBCs
acute agitation treatment
benzos - lorazepam, midazolam
first gen antipsychotics - haldol, droperidol
2nd gen antipsychotics - olanzapine, ziprasidone, risperidone
AEs of testosterone
hypertension
polycythemia
hyperlipidemia
hyperglycemia
AEs of estrogen
increased risk of thrombosis
hypertension
hyperprolacinemia
migraines
serotonin syndrome criteria
serotonergic agent AND one of the following
- spontaneous clonus
- inducible clonus PLUS agitation or diaphoresis
- ocular clonus PLUS agitation or diaphoresis
- tremor PLUS hyperreflexia
- hypertonia PLUS temperature >38 PLUS ocular or inducible clonus
serotonin antagonist
cyproheptadine
s/s of serotonin syndrome
AMS, muscle rigidity, hyperreflexia, hyperactive bowel sounds, diaphresis
neuroleptic malignant syndrome
life threatening idiosyncratic reaction to dopamine antagonists characterized by fever, AMS, muscle rigidity, autonomic dysfunction
tardive dyskinesia
involuntary neurological movement disorder caused by the use of dopamine antagonizing drugs
tardive dyskinesia treatment
ingreza (valbenazine)
austudo (deutetrabenazine)
NMS treatment
lower BP - clonidine
muscle relaxants - dantrolene (but check LFTs before!)
dopamine agonists - bromocriptne
diagnostics for eating disorder
electrolytes - ca, mg, phos
LFTs
CBC
UA w tax
TSH
EKG
BMI <13 - CXR (risk for opportunistic infx)
amenorrhea >6 mos - bone mineral density
eating disorders reasons for emergency hospitalization
hypokalemia, severe electrolyte imbalance, hypoglycemic coma, symptomatic bradycardia, severe hypotension, dehydration, syncope, seizures, QTc prolong, marasmus w BMI <14, psych instability
consequences of prolonged anorexia
leukopenia with lymphocytosis, elevations in BUN, metabolic acidosis, hypokalemia with purging
long term - osteoporosis
refeeding syndrome
medical consequences of bulimia
fluid and electrolyte disturbances
cardiac conduction abnormalities
common exam findings for bulimia
dental erosion, parotid gland enlargement
number one cause of delirium
infection
bulimia meds
SSRI
