Psych Flashcards
Difference between adjustment d/o and Complex bereavement
Adjustment 1st line tx is psychotherapy
Persistent 1st line tx is Antidepressant and psychotehrapy to prevent MDD
What is the onset of Adjustment D/o
onset within 3 months of stressor, lasts 6months after end of stressor
Example of adjustment d/o
Loss of job –> tylenol od
What are characteristics of grief
Searching behaviors, shock/numbness, crying spells
What is the timeframe for grief
6-12 months duration depends on deceased
Define persistent complex bereavement
out of proportion bereavement from expected norms
Inability to deal w/ daily fxn (hygiene, housekeeping)
Desire to be w/ the deceased
Life is meaningless
SIGECAPS
sleep interest Guilt Energy Concentration Appetite Psychomotor stimulation SI
PHQ 9 scoring
1-4 Min 5-9 Mild 10-14 Mod 15-19 Mod/severe >20 severe
Devfinition of MDD
At least 2 weeks of depressed mood or loss of interest + at least 4 additional symptoms
TX for MDD
SSRI first line
Define Dysthymia
2 years of depressed mood for more days than not
-Extreme version of MDD and less common
pt will say they have “felt depressed all their life”
What are the characteristics of BD1
Mania
Lack of sleep
Flight of ideas
Can exist w/o MDD
Characteristics of BD2
MDD w/ at least 1 hypomanic episode (doesn’t affect function)
Is rapid cycling MC w/ BP1 or BP2
BP1
Cyclothymia
at least 2 years of numerous periods of hypomanic sx that don’t meet criteria for mani cpisode
(milder form of BP2)
Gold standard tx for BP
Lithium
DONT give Antidepressants (can shift into hypomanic state)
What levels need to be monitored w/ Li use
LI+ trough level Renal fxn Thyroid ECG CBC Lytes Pregnancy
Dx of GAD
> 3sx for >6mo present on more days than not
Sx of GAD
A lot of non-sepcific MSK complaints Restlessness easy fatigue sleep disturbance dec conc irritability
panic d/o
Recurrent unexpected attacks WITH the fear that those panic attacks will happen again
Tx of choice for panic d/o
psychotherapy
SSRI gold standard
Define Agoraphobia
Fear of places and situation where escape would be difficult
panic can occur concurrently
Stage fright is an example of what?
social phobia
TX for OCD
CBT
SSRI
When can we call sx of PTSD actual PTSD
not until after 30 days with significant occup disruption
If a pt who seems to be exibiting PTSD sx presents before they have been experiencing them for the full 30 day window what do we call this?
ASD
TX for PTSD
SSRI, BBlocker, Prazosin for nightmares
What drug causes worsening of sx in PTSD
BZD
Delusion
Strongly held belief that untrue is true, can be bizarre/not
Hallucination
experiencing something that is NOT PRESENT
Illusion
Distortion of something that IS THERE
Positive sx of schizophrenia
Hallucination Delusions disorganized thought/speech/behavior cognitive impairment These are all things that are not usually present but will present themselves with the psychotic break
Negative sx of schizophrenia
Affective flattening Alogia (poverty of speech) Autism Avolution (No goals or desires) These are all sx that are taking away from the person what they would usually have.
How long must sg last for in order to dx as schizophrenia
> 6mo
What would we define apparent schizophrenia as if it has not yet been 6mo?
Schizophreniform disorder
Schizoaffective disorder define
MDD and mania overlaping with sx of schizophrenia
So-looks like BPD1 (mania and mdd) but add in delusions
1st line Tx for ACUTE schizophrenia presentation
Reduce harmful symptoms
Admit
1st line SGA’s
What are the three clusters of personality d/o
A - Mad
B- Bad
C- Sad
List cluster A disorders
(Mad-a little cooky)
Paranoid
Schizoid
Schizotypal
List cluster B disorders
(Bad-socially unacceptable and dangerous) Antisocial Borderline Histrionic Narcissistic
List cluster C disorders
(Sad-withdrawn)
Avoidant
Dependent
Obsessive Compulsive PD
Define Paranoid personality d/o
preoccupied thoughts of disloyalty
Schizoid personality d/o
Pervasive detachment and restriction of range of expression
“social loners”
lack intimacy
show little emotion
Schizotypal personality d/o
Acute discomfort w/ reduced capacity for close relationships and distortions (MAGICAL THINKING).
Antisocial personality d/o
Disregard for others boundaries
MUST BE AT LEAST 18 FOR Dx
Aggression w/ people and animals
Sociopaths
Borderline personality d/o
Instability/interpersonal relationships
real/imagined abandonment
Impulsivity
“80% chance I might kill myself”
Histrionic personality d/o
Provocative
dramatic
need to be the life of the party
Narcissistic PD
Pattern of grandiosity
Dr. F
Avoidant PD
Avoid places where they might be judged
Often decline job promotions out of fear
low self esteem
shyness
Dependent PD
Pervasive excessive need to be taken care of
Obsessive compulsive personality d/o
different than OCD because they are preoccupied with orderliness, perfection and mental interpersonal control.
Reject help, don’t break rules
Plan ahead in meticulous detail
ME
Difference between conduct d/o and ODD
ODD is negativistic behavior lasting at least 6mo
conduct d/o includes legal issues
Heroin overdose looks like
Pinpoint pupils
Acute CNS and resp depression
Tx for heroin OD
Acute OD- Narcan
Withdrawal meds for heroin
Clonidine dicyclomide loperamide Hydroxyzine ibuprofen
Cocaine OD looks like
dilated (midriasis) pupils CNS stimulation TAchy everything Euphoria paranoia sexual stim
What medication do you need to avoid in cocaine OD
Bblockers!!!
Tx for cocaine OD
Lorazepam IV PRN
IVF
BP management: ntiropursside, or phentolamine (NO BB)
Tx for spice OD
Ativan - Wait it out
Tx for acetaminophen od
Activated charcoal w/in 4h
NAC IV if >8hr, preg, present w/ hepatic failure
ASA od tx
Active charcoal
dialysis if severe
When should ASA levels be checked after OD
6 hours is peak but should check at 4hrs and q3 after until level declines
At 6hrs post ingestion and OD of ASA what level indicate prognosis?
<35 no sx
35-70 mild-mod
70-100 severe
>120 potetially fatal
What medications make up the FGAs
Chrlorpromazine
Fluphenazine
Perphenazine
Haloperidol
acute dystonia
contraction, arching of back, one or both eyes turned upwards, tongue protrusion, jaw clenching
When would you expect to see acute dystonia after initiating FGA
min to hours after FGA is started
Tx for acute dystonia
Anticholinergics (benztropine, diphenhydramine)
BZD
relief should occur w/in 5min
Prevent by co-dosing FGA’s with antichol automatically
Akathesia
Motor restlessness, inner disquiet
Tx of akathesia
BBlockers. Anticholinergics are not helpful! BZD’s are contraindicated
Pseudoparkinsonism
Resembles idiopathic parkinson's Rigidity Tremor Bradykenisia postural instability
Tx for pseudoparkinsonism
Anticholinergic
sx should resolve in 3-4 days
tardive dyskenisia
Abnormal movements, lip smacking, trunk extremities, unusual posture
When does Tardive dyskenisia usually present after taking FGA’s
a year after
Tx for Tardive
Often irreversible
Reassess need for continuation
D/C start atypical if needed
Prevent by checking AIMS q6mo
Describe Neuroleptic Malignant Syndrome
Rare Onset varies Fever (>100.4) AMS Leukocytosis Inc CK and LFT Myoglobinuria
Which SGA is first line d/t ADE profile
Aripiprazole
Which SGA has the worse ADE profle
Chlorpromazine
Why is clozapine not first line?
Agranulocytosis
Which SGA is best for pt’s with QTC prolongation
Aripiprazole
Olanzapine
which SGA is assoc. most with weight gain
Olanzapine
How many days must go by for a washout period when switching from MAOi to any other antidepressant or from another antidepressant to MAOi
14 days
What is the exception to the rule for 14d washout w/ MAOi
Fluoxetine - must have 5 week washout
Why is there a washout period for MAOi’s
Hypertensive crisis may occur
Drug of choice for Classic Mania
Lithium
How does VA compare to LI+
better for mixed states and rapid cycling than LI+
Who do we not give Lamotrigine to
kids under 16 - SJS
Tx for BZD od
flumazenil
