Psych 6 Flashcards
When should you consider diagnosis of MDE instead of bereavement following the lost of a loved one
Sx persist > 2 months, marked functional impairment, morbid preoccupations with unrealistic guilt or worthlessness, suicidal ideation, marked psychomotor retardation
First line tx for acute mania
Valproic acid
Side effects of valproic acid
- GI distress (e.g. nausea and vomiting)
- Increased appetite and weight gain
- Tremor
- Hepatotoxicity
- Pancreatitis
- Teratogenic
Side effects of lithium
- Acute lithium toxicity = GI symptoms (nausea, vomiting, diarrhea)
- Chronic lithium toxicity = Neurologic symptoms (e.g. tremor and ataxia)
- Hypothyroid = Symptoms may include weight gain, dry skin, hair loss, constipation
- Nephrogenic Diabetes Insipidus
Tx of persistent depressive disorder
Venlafaxine (SNRI) and Bupropion (DA/NE reuptake inhibitor)
What type of drug is Amoxapine
TCA
What percentage of new mothers is believed to experience postpartum blues?
30-75% in the 3 to 5 days after delivery
Differentiate between postpartum blues and postpartum depression
Blues = remit spontaneously in days to weeks
Depression = time of onset 3-6 months after delivery
Both have sleep disturbance, tearfulness, and depressed mood
How long after a stroke is a patient most likely to develop a post-stroke depression
6 months
Common trigger of manic episode in bipolar patients
+ tx?
Sleep deprivation
Can use long acting benzo to return normal sleep pattern and abort manic episode
What sx is associated with postpartum depression but not postpartum blues
Anhedonia
What is the most common side effect after ECT
HA
Most common complaints = HA, nausea, and muscle soreness. Memory impairment occurs but less frequently
Time frame of persistent depressive disorder
2 years in adults
1 year in kids!
Monitoring tests that should be done on patients taking Lithium
Creatinine, thyroid function, urinalysis
Sx that differentiate between bereavement and major depression
- Guilt about things other than actions taken or not taken by the survivor at the time of loved ones death
- Thoughts of death other than survivor feeling they would be better off with the loved one
- Morbid preoccupation with worthlessness
- Marked psychomotor retardation
- Marked and prolonged functional impairment
- Hallucinations other than the survivor hearing or seeing the loved one
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
What sx is the most accurate indicator of long-term suicidal risk in patients with MDD
Hopelessness
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
Tx of MDD with melancholic features
TCAs
What is double depression
When a major depressive episode develops in a patient with dysthymic disorder
Likely diagnosis: Delirium + hemiparesis or other focal neuro signs or sx
CVA or mass lesion
Likely diagnosis: delirium + elevated BP + papilledema
Hypertensive encephalopathy
Likely diagnosis : Delirium + dilated pupils + tachycardia
Drug intoxication
Likely diagnosis : Delirium + fever + nuchal rigidity + photophobia
Meningitis
Likely diagnosis : Delirium + tachycardia + tremor + thyromegaly
Thyrotoxicosis
Potential medications for tx of Alzheimers
Anticholinesterase can slow deterioration
- Galantamine, Rivastigmine, Donepezil
Danger of antipsychotics in dementia patients
Carry a black box warning regarding increased risk of death in patients with dementia
Describe onset and characterization of Lewy body dementia
- Early onset dementia (Vs. Parkinson’s which has late onset dementia + Lewy bodies)
- Characterized by dementia and visual hallucinations, followed by Parkinsonian features
Pharmacotherapy for Lewy Body Disease
- Cholinesterase inhibitors for cognitive and behavioral symptoms
- Quetiapine or Clozapine for psychotic symptoms
- Levodopa-carbidopa for Parkinsonism
- Melatonin and/or Clozepam for REM sleep behavior disorder
Describe presentation of frontotemporal lobe dementia
- Cognitive defects in attention, abstraction, planning, and problem solving
- 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
Clinical manifestations of Huntington’s
- Triad of motor, cognitive, and psychiatric symptoms
- Cognitive decline and behavioral changes can precede onset of motor signs by up to 15 years
- Executive function is the primary cognitive domain affected
- Psychiatric manifestations include depression, apathy, irritability, obsessions, and impulsivity
- Patients are often aware of deteriorating mentation
- Movement disorders include chorea and bradykinesia
Clinical manifestation of Parkinson’s
- Motor signs include rigidity, resting tremor, bradykinesia, and postural instability
- Cognitive manifestations consist of executive dysfunction ad visuospatial impairments
- Depression, anxiety, personality changes, and apathy are common
- Psychotic symptoms. Including visual hallucinations and paranoid delusions, may result from the disease itself or as adverse effects of medications used to treat the motor symptoms
Tx of parkinson’s
- Carbidopa-levodopa for motor symptoms
- Cholinesterase inhibitors to target cognitive symptoms
- Reduction in dopamine agonists for psychotic symptoms
- Quetiapine and Clozapine are preferred for treatment of psychotic symptoms that are not responsive to dopamine dose reduction
Clinical manifestation 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 Borderline personality disorder
DBT
What are the 4 categories of Extra-pyramidal symptoms in the order they appear
- Dystonia
- Akathisia
- Pseudoparkinsonism
- Dyskinesia
What is dystonia
Sustained abnormal posturing (e.g. oculogyric crisis, laryngospasm, torticollis)
Tx of Dystonia
Botox for torticollis
Benztropine or diphenhydramine
What is akathisia
Motor restlessness; crawling sensation in legs relieved by walking
Tx of akathisia
Lorazepam, Propanolol or Diphenhydramine
What is pseudoparkinsonism
TRAPS: Tremor, rigidity, akinesia, postural instability, staggering gait
Tx of pseudoparkinsonism
Benztropine
What is tardive dyskinesia
Purposeless, constant movements, involving facial and mouth musculature
Tx of tardive dyskinesia
No good treatment; discontinue drug or reduce dose
