Psych 14 Flashcards
Age cutoff between conduct disorder and antisocial personality disorder
18 y/o
Before = conduct After = antisocial
At what blood alcohol level do signs of intoxication begin
o 20-30 mg/dl
♣ First signs of intoxication
♣ Decrease in fine motor control
At what point of alcohol withdrawal do seizures occur
12-48 hours
At what point of alcohol withdrawal does delirium tremens occur?
48-96 hours
First line tx for alcohol use disorder
Naltrexone (opioid receptor blocker, decreases desire/craving and “high” from alcohol)
Describe presentation of Wernicke’s encephalopathy
Ataxia, confusion, ocular abnormalities
Can be reversed with Thiamine therapy
Describe presentation of Korsakoff syndrome
Impaired recent memory, anterograde amnesia, compensatory confabulation
Reversible in only about 20% of pts
MOA of Methadone
Long acting opioid agonist
Presentation of PCP intoxication
Agitation, depersonalization, hallucinations, synesthesia (one sensory stimuli evokes another), impaired judgement, memory impairment, assaultiveness, nystagmus, ataxia, HTN, tachycardia,high tolerance to pain
Describe withdrawal of PCP
No withdrawal syndrome, but “flashbacks: can occur (recurrence of intoxication due to release of drug from lipid stores)
Tx of barbiturate overdose
ABCs, activated charcoal to prevent further absorption
Alkalanize urine with NaHCO3 to promote renal excretion
Tx of Nicotine dependence
Varenicline/Chantix (1-800-Very-Clean) = nicotinic cholinergic receptor partial agonist
Bupropion = antidepressant that is an inhibitor of dopamine and NE reuptake
Dangers of PCP overdose
Seizures, delirium, coma, death
When you think of psych liver enzymes think…
2D6
Smoking is an inducer of what liver enzyme
1A2
What is significant about Vyvanse (stimulant)
Is a prodrug - so needs to be metabolized by the liver before it becomes active
Which is why it is long acting / extended release
How does Ritalin long-acting (LA) work?
30% of pill is regular release
70% of pill is enterically coated, so will take longer to dissolve and begin working later in the day
So it is basically taking two doses of Methylphenidate in one pill
How does Concerta work
There is an osmotic pump in a non-dissolvable pill. As pill goes through GI tract and water enter the pill via osmotic pump, the pill fills with water and begins to push out the Ritalin that is also within the pill
So it disperses slowly and doesn’t have two spikes like in Ritalin LA
How long can Amphetamines show up in U-tox (urine screen)
2-3 days
What type of stimulants will show up on U-tox and what types wont
U-tox looks for amphetamines, so Adderall and amphetamine derivates will show up by Ritalin and methylphenidate derivatives will not show up
What meds are biggest risk factors for delirium
Benzodiazepines, Anticholinergics, Opiates, Psychotropics
Meds that can be used to treat delirium
Avoid unnecessary meds
Low dose Haldol (0.25-0.5) if agitated - scheduled BID IV for as short amount of time
Make sure to have plan to discontinue
1 risk factor of delirium
Personal history of delirium
What is so crucial about diagnosing delirium
Delirium is a medical emergency
All cause mortality within a year of patient having delirium increased by 50%
Why do you NEVER give Haldol IV
Significant risk of death via arrhythmia QTc prolongation
Percentage of schizophrenia
1%
Sexual arousal from touching or rubbing against a nonconsenting person
Frotteurism
What dementia is characterized by personality changes
Frontotemporal lobe dementia
Average age of onset of FTD
40s
Brain imaging seen in Huntington’s
Caudate atrophy
What is characteristic of prion disease
Rapid deterioration
Difference between tremor in Parkinson’s vs. tremor as antipsychotic side effect
Parkinson’s = asymmetric at first
EPS = symmetric
Cut-off for BMI to distinguish between anorexia and bulimia
18.5%
Tx of bulimia
Fluoxetine high dose
Time frame for delusional disorder
1 month
Substance associated with nystagmus
PCP intoxication or alcohol withdrawal
What are the 3 learning disorder
Specific learning disorder with impairment in:
- Reading
- Writing
- Math
What percentage of new mothers is believed to experience postpartum blues?
30-75% in the 3 to 5 days after delivery
How long after a stroke is a patient most likely to develop a post-stroke depression
6 months
Time frame of persistent depressive disorder
2 years in adults
1 year in kids!
Contraindication to ECT
MI within the past 4 weeks, increased ICP, aneurysms, bleeding disorders, conditions that disrupt BBB
What does brain imaging often display in depressed patients
Reduced metabolic activity and blood flow in both frontal loves on PET scan
Tx of MDD with melancholic features
TCAs
Describe sx of MDD with melancholic features
- Loss of pleasure in all activities
- Lack of reactivity (nothing can make patient feel better)
- Intense guilt
- Significant weight loss
- Early morning awakening
- Psychomotor retardation
Features of Lewy Body dementia
THINK: Creepy Lewy. Is not right in the head (early dementia). Staring at everyone (visual hallucinations). With darty eyes (rapid eye movement disorders - REM)
Core Features:
• Waxing and waning of cognition, especially in the areas of attention and alertness
o Early onset dementia (vs. Parkinson’s which has later onset)
• Visual hallucinations (syntonic – the hallucinations are not disturbing to the patient)
• Development of extrapyramidal signs (Parkinsonism) at least one year after cognitive decline becomes evident
Suggestive Features:
• Rapid eye movement (REM) sleep behavior disorder – violent movements during sleep in response to dreams, often of fighting
• Pronounced antipsychotic sensitivity
Presentation of prion disease
- Insidious onset with rapidly progressive cognitive decline
- Difficulties with concentration, memory, and judgment occur early
- More than 90% of patients experience myoclonus
- Depression, apathy and hypersomnia are also common
- Basal ganglia and cerebellar dysfunction, manifesting as ataxia, nystagmus, and hypokinesia, are present in a majority of individuals
Tx of prion disease
- No effective treatment exists
* Most individuals die within 1 year of diagnosis
Tx of akathisia
Lorazepam, Propanolol or Diphenhydramine
Tx of pseudoparkinsonism
Lower antipsychotic dose
Benztropine
Tx of tardive dyskinesia
No good treatment; discontinue drug or reduce dose
Presentation of Frontotemporal lobe dementia
♣ Age of onset = 40s (earlier than other dementias)
• Early Behavior/personality changes (frontal lobe) and/or aphasia (temporal lobe)
o Behavior = disinhibited, overeating, lack of emotional warmth/sympathy, apathy, perseveration, decline in social cognition and/or executive abilities
o Language = difficulties with speech and comprehension
• Late Dementia
