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MS3 > Psych 6 > Flashcards

Psych 6 Flashcards

1
Q

When should you consider diagnosis of MDE instead of bereavement following the lost of a loved one

A

Sx persist > 2 months, marked functional impairment, morbid preoccupations with unrealistic guilt or worthlessness, suicidal ideation, marked psychomotor retardation

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2
Q

First line tx for acute mania

A

Valproic acid

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3
Q

Side effects of valproic acid

A
  • GI distress (e.g. nausea and vomiting)
  • Increased appetite and weight gain
  • Tremor
  • Hepatotoxicity
  • Pancreatitis
  • Teratogenic
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4
Q

Side effects of lithium

A
  • 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
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5
Q

Tx of persistent depressive disorder

A

Venlafaxine (SNRI) and Bupropion (DA/NE reuptake inhibitor)

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6
Q

What type of drug is Amoxapine

A

TCA

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7
Q

What percentage of new mothers is believed to experience postpartum blues?

A

30-75% in the 3 to 5 days after delivery

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8
Q

Differentiate between postpartum blues and postpartum depression

A

Blues = remit spontaneously in days to weeks

Depression = time of onset 3-6 months after delivery

Both have sleep disturbance, tearfulness, and depressed mood

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9
Q

How long after a stroke is a patient most likely to develop a post-stroke depression

A

6 months

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10
Q

Common trigger of manic episode in bipolar patients

+ tx?

A

Sleep deprivation

Can use long acting benzo to return normal sleep pattern and abort manic episode

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11
Q

What sx is associated with postpartum depression but not postpartum blues

A

Anhedonia

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12
Q

What is the most common side effect after ECT

A

HA

Most common complaints = HA, nausea, and muscle soreness. Memory impairment occurs but less frequently

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13
Q

Time frame of persistent depressive disorder

A

2 years in adults

1 year in kids!

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14
Q

Monitoring tests that should be done on patients taking Lithium

A

Creatinine, thyroid function, urinalysis

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15
Q

Sx that differentiate between bereavement and major depression

A
  • 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
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16
Q

Contraindication to ECT

A

MI within the past 4 weeks, increased ICP, aneurysms, bleeding disorders, conditions that disrupt BBB

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17
Q

What does brain imaging often display in depressed patients

A

Reduced metabolic activity and blood flow in both frontal loves on PET scan

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18
Q

What sx is the most accurate indicator of long-term suicidal risk in patients with MDD

A

Hopelessness

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19
Q

Describe sx of MDD with melancholic features

A
  • 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
20
Q

Tx of MDD with melancholic features

A

TCAs

21
Q

What is double depression

A

When a major depressive episode develops in a patient with dysthymic disorder

22
Q

Likely diagnosis: Delirium + hemiparesis or other focal neuro signs or sx

A

CVA or mass lesion

23
Q

Likely diagnosis: delirium + elevated BP + papilledema

A

Hypertensive encephalopathy

24
Q

Likely diagnosis : Delirium + dilated pupils + tachycardia

A

Drug intoxication

25
Q

Likely diagnosis : Delirium + fever + nuchal rigidity + photophobia

A

Meningitis

26
Q

Likely diagnosis : Delirium + tachycardia + tremor + thyromegaly

A

Thyrotoxicosis

27
Q

Potential medications for tx of Alzheimers

A

Anticholinesterase can slow deterioration

- Galantamine, Rivastigmine, Donepezil

28
Q

Danger of antipsychotics in dementia patients

A

Carry a black box warning regarding increased risk of death in patients with dementia

29
Q

Describe onset and characterization of Lewy body dementia

A
  • Early onset dementia (Vs. Parkinson’s which has late onset dementia + Lewy bodies)
  • Characterized by dementia and visual hallucinations, followed by Parkinsonian features
30
Q

Pharmacotherapy for Lewy Body Disease

A
  • 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
31
Q

Describe presentation of frontotemporal lobe dementia

A
  • 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
32
Q

Clinical manifestations of Huntington’s

A
  • 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
33
Q

Clinical manifestation of Parkinson’s

A
  • 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
34
Q

Tx of parkinson’s

A
  • 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
35
Q

Clinical manifestation of prion disease

A
  • 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
36
Q

Tx of Prion disease

A
  • No effective treatment exists

* Most individuals die within 1 year of diagnosis

37
Q

Tx of Borderline personality disorder

A

DBT

38
Q

What are the 4 categories of Extra-pyramidal symptoms in the order they appear

A
  1. Dystonia
  2. Akathisia
  3. Pseudoparkinsonism
  4. Dyskinesia
39
Q

What is dystonia

A

Sustained abnormal posturing (e.g. oculogyric crisis, laryngospasm, torticollis)

40
Q

Tx of Dystonia

A

Botox for torticollis

Benztropine or diphenhydramine

41
Q

What is akathisia

A

Motor restlessness; crawling sensation in legs relieved by walking

42
Q

Tx of akathisia

A

Lorazepam, Propanolol or Diphenhydramine

43
Q

What is pseudoparkinsonism

A

TRAPS: Tremor, rigidity, akinesia, postural instability, staggering gait

44
Q

Tx of pseudoparkinsonism

A

Benztropine

45
Q

What is tardive dyskinesia

A

Purposeless, constant movements, involving facial and mouth musculature

46
Q

Tx of tardive dyskinesia

A

No good treatment; discontinue drug or reduce dose

MS3 (88 decks)

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