Psych Flashcards
Diagnosis of depression requires 5 symptoms including one of the following:
depressed mood
anhedonia
Labs to work up depression include…
TSH
Categories of feelings
mad, sad, glad, afraid, ashamed
Stages of grief
Denial, anger, bargaining, depression, acceptance
Management of depression
psychotherapy
possible antidepressants- SSRIs, lesser used TCAs and MAOIs
Seratonin syndrome presents with
high fever
Risks of MAOIs
wine + cheese = hypertensive crisis
Risk of TCAs
anticholinergic effects such as dry mouth and constipation
prolonged QT
dysthymia
chronic form of depression lasting at least 2 years, often since childhood
Anxiety: definition
unpleasant feeling of dread, aprehension, or tension resulting from an unexpected threat to one’s feeling of self esteem or well being
Generalized anxiety disorder
excessive worry/anxiety about life circumstances
Panic disorder
morbid dread of seemingly harmless object/situation; may lead to agoraphobia
Obsessive compulsive disorder
repetitive thoughts that a person is unable to control and/or urge to perform a task that cannot be resisted which interferes with normal ADLs
Post traumatic stress disorder
anxiety for at least 6 months after a severe trauma, characterized by flashbacks, nightmares, and intrusive thoughts
Labs to check for anxiety disorders
TSH, serum drug analyses, glucose, EKG
Management of anxiety
Cognitive behavioral therapy
Anti-anxiety medications- benzodiazepines, antihistamines, beta blockers, TCAs and MAOIs, buspirone (Buspar)
Suicide: incidence
- increased risk in adolescents and white males >45 years old (especially with sudden loss of partner)
- mental or substance abuse disorders account for >90percent of all suicides
Suicide screening test, “SUICIDAL”
Sex Unsuccessful attempts Identified family members with attempt history CI- chronic illness history Depression, drug abuse, drinking Age Lethal method available
“CAGE” pneumonic
C- Have you ever felt the need to cut down on your drinking?
A- Have people annoyed you by criticizing your drinking?
G- Have you ever felt guilty about your drinking?
E- Have you ever had a drink first thing in the morning?
Who diagnoses alcoholism?
The patient has to say they have alcoholism
Rule out other diseases with dementia diagnosis
Drug reactions/interactions Emotional disorders Metabolic/endocrine disorders Eye/ear disorders Nutritional problems Tumors Infection Arteriosclerosis
Alzheimer’s disease is characterized as:
memory impairment + one of the following: aphasia apraxia agnosia inability to plan, organize, sequence
aphasia
difficulty with speech
apraxia
inability to perform a previously learned task
agnosia
inability to recognize an object
What is the cause of Alzheimer’s?
Acetylcholine deficiency
Management of Alzheimer’s
Neuro consult
Meds to increase the availability of acetylcholine
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
May be prescribed in conjunction with NMDA receptor agonists such as Namenda (memantine)
What is the cerebellum responsible for?
balance and coordination
Romberg test
Evaluates cerebellar function
Feet together, eyes closed, arms at sides
Positive Romberg if patient has a loss of balance
Finger to nose test
Evaluates cerebellar function
Patient alternately points from his nose to the examiner’s finger
Heel to shin test
Evaluates cerebellar function
Run heel of foot along the shin of the opposite leg
Cranial Nerves
S CN I: Olfactory S CN II: Optic M CN III: Oculomotor M CN IV: Trochlear B CN V: Trigeminal M CN VI: Abducens B CN VII: Facial S CN VIII: Acoustic/ Vestibular B CN IX: Glossopharyngeal B CN X: Vagus M CN XI: Spinal accessory M CN XII: Hypoglossal
What is the most important history item when evaluating headache?
Chronology
Tension headache
90 percent of all headaches vise-like, tight generalized, often worse in neck or back of head usually last several hours treat with OTC analgesics, relaxation
Migraine headache
Classic (with aura) and common (without aura)
Related to dilation and pulsation of branches of external carotid
Typically last 2-72 hours, trigeminal nerve pathway
onset in adolescence or early adulthood, females > males
assoc with triggers (smells, menses, alcohol, sleep problem, missed meals, oral contraceptives, nitrates in food, weather changes)
unilateral, dull or throbbing, may have neurological disturbances
Treatment of migraines
Avoidance of triggers
Relaxation/stress management
ASA/triptans for acute attack
Prophylactic therapy if more than 2-3x/month:
amitryptyline, depakote, propranolol, verapamil, clonidine, topamax, gabapentin, magnesium
Cluster headaches
mostly affecting middle aged men
may be preceded by alcohol intake
severe, unilateral, periorbital, occurs daily for several weeks
may occur at night/awaken patient
last less than 2 hours; pain free for weeks-months between attacks
ipsilateral congestion, rhinorrhea, eye redness
Tx: Triptans, inhalation of 100 percent oxygen
How long do TIA symptoms last?
Less than 24 hours, but if more than 3 hours, it is more likely to turn into a stroke.
What is hemiopia?
loss of half of visual field
TIA classifications
- Vertebrobasilar
2. Carotid
Lab/Dx for TIA
CT, MRI, CTA
echo, carotid US
Treatment of TIA
Aspirin, Plavix
Assess for hypertension
Carotid endarterectomy if indicated
When is carotid endarterectomy indicated?
Stenosis >70 to 80 percent in symptomatic patients
What is the #1 cause of heart failure?
Hypertension
Partial seizure: Simple
No loss of consciousness
Usually
Partial seizure: complex
any simple partial seizure followed by impaired level of consciousness
Generalized seizure: absence (petit mal)
Blank stare
Usually discovered in children/adolescents
Begin and end suddenly
Generalized seizures: tonic clonic (grand mal)
may have aura tonic contractions, loss of consciousness, then clonic contractions usually lasts 2-5 minutes incontinence may occur followed by postictal period
Status epilepticus
Series of grand mal seizures of >10 minutes duration
medical emergency
patient never regains consciousness between seizures
uncommon, but can be life threatening
Seizure management
CT scan, EEG
during seizure: maintain open airway, benzodiazepines
anti-seizure meds should be tapered and never abruptly withdrawn
Parkinsons
Dopamine deficiency
Onset usually between 45 and 65 years old
S/sx: tremor, rigidity, bradykinesia, Myerson’s sign
Myerson’s sign
repetitive tapping over bridge of nose produces a sustained blink response
signifies Parkinsons disease
Management of Parkinsons
Increasing dopamine (trouble standing/getting up)
- carbidopa levodopa
Anticholinergics (tremor/rigidity)
- benztropine (Cogentin)
Myasthenia Gravis
autoimmune, reduction in number of acetylcholine receptor sites
predominant in women 20-40 years old
Sx: weakness worse after exercise and better after rest, ptosis (droopy eyelid), diplopia, dysarthria, dysphagia, extremity weakness, fatigue, respiratory difficulty, DTRs are NORMAL
Dx: antibodies to acetylcholine receptors
Tx: neurology referral
Multiple sclerosis
autoimmune, body attacks myelin
predominant in white women 20-50 years old
Sx: numbness, weakness, loss of muscle coordination, problems with vision, speech and bladder control, diplopia, disequilibrium
Dx: slightly elevated protein in CSF on lumbar puncture, MRI of brain
Tx: refer to neurology
Bell’s palsy
affects cranial nerve VII, facial nerve
idiopathic, but may be related to herpes virus reactivation
abrupt onset of facial paresis
may be accompanied by pain around the eye
UNABLE to move forehead (stroke patients CAN move forehead)
Tx: prednisone taper, Acyclovir if zoster infection suspected, lubricating eye drops and patch at night if unable to close, neurology referral as needed
What differentiates stroke and Bell’s palsy facial paralysis?
Stroke CAN move forehead
Bell’s palsy CAN’T move forehead
Trigeminal neuralgia
affects cranial nerve V, trigeminal
electric-shock-like pains in parts of the face (unilateral)
causes: MS, or pressure on the trigeminal nerve from swollen blood vessel or tumor
Dx: neuro exam, MRI, trigeminal reflex testing
Tx: antiseizure drugs, muscle relaxants, TCAs
