Psych Flashcards
Worse than blues, also has sleep disturbances and change in appetite. Lasts months after giving birth.
Postpartum depression
Common in 50-70% of women after birth. Starts in first few days and resolves in 2 wks. Increased tearfulness, restlessness and anxiety. Tx is support and reassure
Postpartum blues
Severe anxiety after giving birth with agitation, disordered thoughts, confusion and may harm child. Hospitalize.
Postpartum mania or psychosis
PMDD
PMS with more sever sx. Treatment with SSRI
What is the initial assessment for a suspected antifreeze ingestion?
Examine urine with woods lamp.
Withdrawal characterized with dysphoric mood, n/ v, muscle aches, yawning, diarrhea, lacrimation, rhinorrhea, sweating, fever and insomnia
Opioid withdrawal
Withdrawal with autonomic hyperactivity, hand tremor, insomnia, hallucinations, psychomotor agitation, seizures and anxiety
Xanax withdrawal (benzo)
Withdrawal with fatigue, unpleasant dreams, insomnia, hypersomnia, increased appetite, psychomotor retardation, anxiety
Amphetamine withdrawal
Withdrawal with fatigue, unpleasant dreams, insomnia, increased appetite, psychomotor retardation, anxiety
Amphetamine or cocaine withdrawal
Atypical antipsychotic used in resistant schizophrenia. Can cause agranulocytosis, seizures, myocarditis, and psychosis.
Clozapine
Disorder when Physical sx are constant with true illness but are under voluntary control of the patient. May have secondary gains.
Fictitious disorder
First line med in depression?
SSRI
MAOI (phenelzine) contraindicated in patients who take () because it may cause delirium, hyperpyrexia, convulsions and HTN.
Meperidine (Demerol)
Causes microcephaly, short palprable fissure, cardiac defects, large ears, under sized jaw and small eyes.
Fetal alcohol syndrome
Panic disorder treatment.
Cognitive behavior therapy (exposing patient to offending stimuli) along with SSRI
Institutionalized patient presents with polyuria, vomiting, diarrhea, difficulty concentrating, confusion and lethargy. What could this be?
Psychogenic polydipsia.
What is acute dystonic reactions!
Occur as a result of taking antipsychotics or raglan for over 12 wks. Patients often given an anti cholinergic with the antipsychotic to decrease side effects.
What are they extra pyramidal side effects?
Tremor, slurred speech, akathesia, dystonia, anxiety, distress, paranoia, bradyphrenia.
Best treatment for depression after stroke?
SSRI
Side effects of lithium?
Nephrogenic diabetes insipidus, thyroid suppression, leukocytosis
Withdrawal causing tremors, diaphoresis, hyper reflexes, elevated vital signs and anxiety
Alcohol
Excessive altered mental status, hallucinations, autonomic instability, seizures and death are all sx of excessive withdrawal from?
Alcohol, delirium tremens
Use and side effects of respiridone?
Atypical antipsychotic for tx of schizophrenia . Extrapyrimdial effects, tardive dyskinesia, neuroleptic sx.
What is tardive dyskinesia?
Sudden uncontrollable movements of voluntary muscles. Usually mouth tongue cheeks and jaw. Lip smacking, puffing checks, protruding tongue etc.
Akathisia
Restlessness and psychomotor agitation from taking antipsychotics or reglan
Persistent pattern of negative, hostile, defiant behavior towards adults.
Oppositional defiant disorder
Drug that causes aggression, distortion of body image, ataxia, nystagmus, mid dilated pupils, fever, hyper salivation. Treatment?
PCP is drug. Treat with diazepam initially…. May need haldol.
Most common side effect of zyprexa, an atypical antipsychotic?
Weight gain contributing to DM2
What do you give for someone going through heroin withdrawal?
Benadryl
Disorder when patient develop somatic sx that are not explained by other disorders, usually after a traumatic experience
Conversion disorder
Disorder common in hospitalized elderly. Rapid onset of impaired cognition, changes in LOC, disturbances in attention and psychomotor activity.
Delirium
Luvox/fluvoxamine
SSRI
Side effects of TCA?
Blurred vision, mydriasis, dry mouth, ortho static hypotension, weight gain, urinary retention, prolonged t wave
Personality disorder described as instability in personal relationships, poor self image, impulsivity, recurrent suicidal behavior, chronic feelings of emptiness, paranoid ideation, cutting, substance abuse and sexual promiscuity.
Borderline personality
Personality disorder who is distrustful or suspicious, fear of confiding in others, perceive threats everywhere, socially isolated, avoids intimacy, prides on being rational and objective but appears unemotional and hyper vigilant.
Paranoid personality disorder
Personality: detached with limited emotional expression, indifferent and little interest in sex, works alone with no friends, enjoys solitary pursuits, can’t deal with strong emotion,
Schizoid personality disorder, schizoid/avoid
Personality with magical thinking, believes in ESP, behavioral eccentricities, discomfort with close relationships, unusual beliefs outside of the norm, may talk to self in public or have vague speech
Schizotypal personality disorder, typal/magical
Personality: disregard for others, behavior violates others, lack of remorse or empathy, law breakers, lying, must be over 18, hostile, may appear charming
Antisocial personality disorder (serial killers)
Personality disorder with unstable self image, unstable relationships, rage, despair. Have difficulty knowing between fantasy and reality, rapid mood swings, impulsivity, usually substance abuse
Borderline personality disorder (think crazy fan)
Personality with excessive attention seeking, center of attention, influenced easily, provocative. Overly concerned with appearance and may be perceived as vain. Threatened by anything that threatens sense of physical attractiveness.
Histrionic personality disorder
Personality that needs praise or admiration. Entitled, conceited, arrogant with a lack of empathy. Self important, blind ambition, fantasy of unlimited success, they are special
Narcissistic personality disorder
Personality that is submissive and has an excessive need to be cared for. Will not initiate anything, fear that illness leads to abandonment, clingy, may agree with everyone, right or wrong
Dependent personality disorder
Personality that desires close relationships but avoids them, intense feelings of inadequacy, sensitive to criticism, fears rejection and humiliation,
Avoidant personality disorder
Personality who is a perfectionist. Require order and control. Attentions to detail impairs ability to finish projects. * patient thinks that obsessions or compulsions are NORMAL.
Obsessive compulsive personality disorder
How long must one have sx before a dx of schizophrenia can be given?
6 months
Disease associated with auditory hallucinations, bizarre delusions, disorganized speech, catatonic behavior, social withdrawal, lack of emotion, lack of communication and lack of reactivity…. Must have functional decline
Schizophrenia
This type of schizophrenia had delusions of persecution or grand urge, is tense suspicious and guarded
Paranoid schizophrenia
This type of schizophrenia is when one regresses to a primitive state, has unorganized behavior, and inappropriate emotional response
Disorganized schizophrenia
This schizophrenia is rare and has marked decrease in motor function, stupor, rigidity and posture.
Catatonic
How do you treat schizophrenia?
Psychosocial rehab and antipsychotics.
Haloperidol
First gen antipsychotic, can cause extrapyrimidal side effects.
Clozapine
2nd gen atypical antipsychotic, can cause agranulocytosis
Risperidone
2nd gen atypical antipsychotic, can cause increase in prolactin levels
Olanzapine
2nd gen atypical antipsychotic, can cause weight gain
Disorder that can cause multiple issues and multiple sx. Poly surgery is a feature, multiple physical complaints that MUST cause significant role impairment. 4 pain, 2 GI, 1 sexual, 1 pseudo neurological complaint.
Somatization disorder
Disorder resulting in a loss or change in sensory or motor function. Suggestive of physical disorder but caused by psychological factors. Usually have depression/anxiety disorder. NOT intentional. Rule out medical causes first.
Conversion disorder
Disorder with long hx of severe pain not consistent with clinical findings. Pain is the cause of all life troubles. Women more than men, poor prognosis.
Pain disorder (somatoform pain disorder)
A fear or belief that one had a serious undisguised dz, patients doctor shop when they get the “wrong” diagnosis of normal.
Hypochondriasis
Self induced sx or false lab or physical exam results, usually women with medical background
Fictitious disorder
Parent creates illness in child to maintain relationship with clinician
Munchausen by proxy
Disorder with refusal to maintain a normal weight. Loses weight, introverted, feels in control with food, abuses laxatives.
Anorexia
A binge eater followed by behavior to prevent weight gain. Minor weight changes, extroverted, shame, feels out of control with food.
Bulemia
Treatment of eating disorder?
Psychotherapy and cognitive behavior therapy, fluoxetine for bulimia, NO Wellbutrin!
Childhood disorder with impairment in areas of development and social skills, communication skills,
Autism, refer to specialty care
Distractibility, short attention span, hyperactive and impulsive. Must be present in greater than 1 setting, l,onager than 6 months and onset before age 7.
ADHD with behavior modification and stimulant drugs
A persistent patter of negative, hostile, defiant behaviors toward adults. Arguments, temper, deliberate annoyance, hx of school and family conflict, low self esteem, mood lability
Oppositional defiant disorder, tx with behavior therapy
Hx of social and academic difficulty, defies authority, fights, throws tantrums, fails in ,school, sets fires, steals, cruel to animals and people. Sexually aggressive, no guilt or remorse. Poor prognosis and must be under 18.
Conduct disorder
Inherited disorder with onset in childhood, unknown cause of tics or vocal tics
Tourette syndrome, tx with atypical neuroleptics like respiridone, haldol and clonadine
How do antipsychotics work.
Block dopamine receptors, effective in treating positive sx.
Side effects of antipsychotics?
Restlessness, weight gain, anti cholinergic (dry mouth, constipation, urinary retention)
How does an SSRI work?
Binds to serotonin reputable proteins inhibiting the reuptake, onset up to 6 wks.
SNRI mechanism of action?
Inhibits the reuptake of serotonin and norepinephrine, treats major depression, mod disorders, OCD, use with caution I. HTN and with St. John’s wort. Effexor, cymbalta, pristiq
What is the MAOI mechanism of action?
Inhibits presynaptic mono amine oxidase which catabolizes norepinephrine dopamine and serotonin
What do you avoid eating when taking an MAOI?
Aged cheese, beer, red wine,
What is the mechanism of action of bupropion?
Inhibits the uptake of dopamine and norepinephrine
Bupropion is contraindicated when?
In patients with seizure risk, decreases the seizure threshold.
When do you use benzodiazepines?
Used for anxiety, agitation, insomnia, augments the GABA function in the lymbic system.side effects are drowsiness and respiratory depression.
What is the use of buspirone (buSpar)?
Tx for generalized anxiety disorder, takes weeks to not improvement, side effects are dizziness, nervousness and nausea
Use for lithium?
Mood stabilizer, must monitor levels on a regular basis, adjust dose with renal decline
Side effects of lithium?
Minor- tremor, wt gain, polyuria, GI distress, acne
Major- ataxia, confusion, course tremor, coma, sinus arrhythmia, teratogenicity, death
Chronic mental illness with psychosis, disorganized speech, auditory hallucinations, thought disorder, delusions for over 6 months, function decline, begins in 20’s
Schizophrenia
Bipolar 1 disorder
At least one manic episode, a period of elevate or irritable mood with grandiosity, flight of ideas, racing thoughts, decreased need for sleep, excessive pleasurable activity
Brief psychotic disorder
Psychotic sx last greater than 1 day and less than one month, may follow a stressor
Delusional disorder
Non bizarre delusions for at least one month
Schizophreniform disorder
Schizophrenia lasting more than one month but less than 6 months
What lab tests are required during long term lithium treatment?
TSH every 6 months
Describe PCP intoxication
Nystagmus, flushing, sweating, distortions of body image, disorganized thinking, irritability, anger
Common drug that causes depression
Propranolol
Side effects of captropril?
Cough, rash, fever, hyperkalemia
Captopril contraindications?
Bilateral renal artery stenosis
Side effects of furosemide?
Potassium depletion hyperglycemia , hyperuremicemia, ypocalcemis
Furosemide contraindicated in?
Hyperuricemia, gout, primary aldosteronism
Side effects of minoxidil?
Hair growth, tachycardia, fluid retention
Minoxidil contraindications?
Patients with severe coronary artery disease.
Overdose of benzo? (Valium, lorazepam, diazepam)
Give flumazemil 0.2mg IV
