Psych Flashcards
What must be seen in mental retardation
Deficits in both intellectual functioning and social adaptive functions
Epidemiology of mental retardation
M>F
Highest incidence in school age
Level of functioning w/ IQ 50-70
6th grade education
Work and live independently
Needs help in stressful situations
Level of functioning w/ IQ 30-40 to 50-55
2nd grade education
Work w/ supervision
Needs help in mild stressful situations
Level of functioning w/ IQ 20-25 to 35-40
Little to no speech
Limited in ability to self-care
Level of functioning w/ IQ
Needs continuous care and supervision
Rx Mental retardation
Genetic counseling, prenatal care, safe environment for expectant mothers
Rx medical disorder if it’s the cause
Special education
Behavioral therapy
What are pervasive developmental disorders
Characterized by social interactions behavior and language
Occur before age 3
Which childhood developmental disorder has a greater incidence in girls
Rett
Features of autism
Lacks peer relationships and social smile Poor eye contact Absent/bizarre speech Repetitive behaviors Self-injurious
Features of Rett
Progressive encephalopathy Microcephaly Hand-wringing Loss of speech Ataxia Psychomotor retardation
Features of childhood disintegrative disorder
NL development for 2 yrs then marked regression
Loss of language, social interaction, motor fn, bladder fn
Features of Asperger
Problems with social interaction and behaviors
No language or intellectual deficits
Preoccupied with rules
Rx Autism
Improve relationships
Behavior modification
Rx Rett
Symptomatic rx
Behavior therapy
Physiotherapy
Rx childhood disintegrative disorder
Improve relationships
Behavioral modification
Rx Asperger
Improve relationships
What must be ruled out if child doesn’t respond to name being called
Deafness
ADHD
Inattention, short attention span or hyperactivity that interferes with daily functioning for >6mos usually starting at age 7 in 2 locations
First line rx ADHD
Methylphenidate
Dextroamphetamine
Side effects of First line ADHD meds
Insomnia
Decreased appetite
HA
Second line rx ADHD
Atomoxetine - chosen over 1st line due to better side effect profile
Who gets oppositional defiant disorder
Age 8
Boys before puberty, Equal after
Who gets conduct disorder
M>F
Parents have antisocial personality disorder and alcohol dependence
Features of oppositional defiant disorder
Argue, lose temper, blame others
Problems with authority
Features of Conduct disorder
Break rules
Bully, cruelty to animals, fighting, use weapons, crime
Rx oppositional defiant disorder
Teach parents appropriate child management skills
Rx conduct disorder
Behavioral intervention using rewards for prosocial and non-aggressive behavior
Tourette
Multiple tics for >1yr before 18
Common motor tics in tourette
Head shaking
Blinking
Common vocal tics in tourette
Grunting
Throat clearing
Coughing
Epidemiology of tourettes
M>F by age 7
Rx Tourette
DA antagonists (risperidone)
Major depression
At least 2 weeks of anhedonia + 4 of
- Weight changes
- Sleep changes
- Poor concentration
- Thoughts of death and worthlessness
- Psychomotor disturbances
MC medical cause of depression
Hypothyroidism
MC neuro cause of depression
Parkinson
Dementia
First line Rx depression
SSRI - Increase the dose if some but not full response
Psychotherapy
SSRI to use if depression + neuropathic pain
Duloxetine
SSRI to use if depression who is fearful of weight gain or sexual side effects
Buproprion
What are manic symptoms
Elevated mood Increased self esteem Distractibility Pressured speech Decreased need for sleep Increase in goal-directed activity Racing thoughts Excessive involvement in pleasurable activities
What to r/o in bipolar
Cocaine or amphetamine use
Bipolar
Manic sx for at least 1 week
How long do hypomanic sx last for
Less than a week
Rx acute mania
Lithium
Rx bipolar depression
Lithium or lamotrigine
Rx acute mania with severe sx
Atypical antipsychotics
Dysthymia
Depressed mood lasting throughout the day for 2 or more years
Rx dysthymia
Antidepressants
Psychotherapy
Cyclothymia
Hypomanic episodes and mild depression for more than 2 years
Rx cyclomania
Li
Valproate
Carbamazepine
Psychotherapy
Characteristics of atypical depression
Increased sleep Increased weight Increased appetite Worse in evening Extremities feel heavy
Rx atypical depression
SSRIs or MAOIs
Rx seasonal affective disorder
Phototherapy
Bupropion
Onset of postpartum blues
Immediately to up to 2 weeks after birth
Onset of postpartum depression
Within 1-3 months after birth
Onset of postpartum psychosis
Within 2-3 weeks after birth
Sx postpartum blues
Sadness
Mood lability
Tearfulness
Sx postpartum depression
Depressed mood
Wt changes
Sleep changes
Excessive axiety
Sx postpartum psychosis
Depression
Delusions
Thoughts of harm
Mother wants to harm baby
Postpartum psychosis
Rx postpartum blues
Nothing, self-limited
Rx postpartum depression
Antidepressants
Rx postpartum psychosis
Antipsychotics
Li
Antidepressants
Duration of bereavement
Less than 6 months but can go on longer
Dx of major depression over bereavement
Thoughts of death Morbid preoccupation of worthlessness Marked psychomotor retardation Psychosis Prolongued functional impairment Sx last longer than 2 months
AE TCAs
Hypotension Dry mouth Constipation Arrhythmias Sexual side effects Wt gain GI disturbances
AE MOAs
Hypertensive crisis w/ foods high in tyramine
AE SSRIs
HA
Wt changes
Sexual side effects
GI disturbances
AE SNRIs
HTN Blurry vision Wt changes Sexual side effects GI disturbances
AE Bupropion
Seizures
AE Trazodone
Priapism
AE Mirtazipine
Wt gain
Sedation
AE Lithium
Tremors, wt gain, GI disturbance, nephrotoxic, teratogen
Leukocytosis DI
Confusion, ataxia, lethargy, abnormal reflexes
AE Valproic acid
Tremors, wt gain, GI disturbance, hepatotoxic, teratogen
Alopecia, hyponatremia, coma
AE Almotrigine
SJS
AE ECT
HA
Transient memory loss
Most effective treatment for depression
ECT
When is ECT given for depression
Suicidal pts who don’t respond to therapy
Sx of serotonin syndrome
Cognitive effects - agitation, confusion, hallucinations
ANS Sx
Somatic effects - tremors, myoclonus
Rx serotonin syndrome
Stop SSRI
Rx Sx
Cyproheptadine
Duration of brief psychotic episode
> 1 day
Duration of schizophreniform
> 1 mo
Duration of Schizophrenia
> 6mo
Rx all psychotic disorders
Antipsychotics
Important for diagnosing schizophrenia
UDS to rule out cocaine or amphetamines
Schizophrenia type with earliest onset and worst prognosis
Disorganized
Schizophrenia w/ lack of positive sx
Residual
When to hospitalize schizophrenics
Acutely psychotic
Schophrenic needs meds in emergency situation w/ IM injection, what to give
Olazapine
Ziprazidone
Rx schizophrenic, non-compliant
Risperidone (long-acting)