Psych Flashcards
Which 2 meds are approved for autism spectrum disorder?
risperidone and aripiprazole for aggression
What is the best treatment for ADHD?
Atomoxetine (norepinephrine reuptake inhibitor) because better side effect profile than methylphenidate/dextroamphetamine (stimulants)
Disruptive Mood Dysregulation Disorder
Chronic, severe, persistent irritability w/ temper outbursts
Must be almost every day w/o period > 3 mo without symptoms
Out of proportion to situation
What sleep disturbances are associated w/ MDD?
Dec REM latency
Inc REM sleep
What is first line for MDD? What are some Alt Med Regimens for MDD?
1 = SSRI
If also have neuropathic pain - duloxetine (NE reuptake inhibitor)
If afraid of wt gain and sex side effects - bupropion
If smoking cessation - buproprion
If also trouble with sleeping - mirtazapine (sedation)
If atypical features (inc sleep, inc wt, inc appetite, worse in evening, feel heavy) - MAOIs (phenelzine, isocarboxazid, tranylcypromine)
Side Effect of Buproprion
lowers seizure threshold
Bipolar 1 v. 2
1 - mania (1 wk, warrant hospitalization) + depression
2- hypomania (< 1 wk, no hospitalization) + depression
Tx of bipolar disorder in pregnancy
may use lurasidone
Persistent Depressive Disorder
Depressed mood almost every day for > 2 yrs but less severe
Tx = SSRI + CBT
Cyclothymic Disorder
Hypomania + mild depression for > 2 yrs
Tx = lithium, valproic acid, antipsychotics + CBT
How do you tell normal bereavement v. MDD?
Normal = sad, worried about dead, dec sleep, tearful; 6 mo - 1 yr, tx is therapy alone
Red Flags = thoughts of death, morbid, marked psychomotor slowing, psychosis, functional impairment for long period of time, sx > 2 wks
Lithium Toxicity
Confusion, ataxia, lethargy, abnormal reflexes
What is the most effective treatment of depression?
ECT
Serotonin Syndrome + Tx
- agitation, confusion, hallucinations, hypomania
- autonomics (sweating, tachy, hyperthermia, nausea, diarrhea, shivering)
- Tremor, myoclonus
Tx = stop meds, CYPROHEPTADINE
What is the first line therapy for schizophrenia?
Atypical antipsychotics
- olanzapine, ziprasidone (short-acting, IM in emergency)
- risperidone and paliperidone (long-acting, good if low compliance)
- others … quetiapine, apiprazole, asenapine, iloperidone
- lurasidone in pregnancy
Main side effect of olanzapine
O - obesity (wt gain and DM)
Main side effect of risperidone
Movement disorders
Main side effect of quetiapine
good if existing movement disorder because lowest incidence
Main side effect of ziprasidone
Prolonged QT (“zips thru the QT”)
Main side effect of clozapine
ONLY USE IF OTHERS FAIL
agranulocytosis (check CBC periodically) and cardiomyopathy
Main side effect of aripiprazole
compulsive behavior (gambling)
What is the timing of side effects in typical anti-psychotics?
1- w/in hrs to day - acute dystonia (tx = benztropine)
2- weeks - akathisia/restlessness (Tx = dec dose, switch to atypical, beta blocker)
3- 6 mo + - tardive dyskinesia (tx = switch to atypical)
**Neuroleptic malignant syndrome can occur at any time (tx = dantrolene or bromocriptine)
What other disorders are treated w/ SSRI as first line? (8)
- panic disorder (1 mo worrying about attacks)
- OCD (ego dystonic)
- Hoarding disorder
- Body dysmorphic disorder
- PTSD (paroxetine and sertraline specifically)
- GAD (> 6 mo)
- Anorexia and bullimia (+ CBT)
Schizoaffective v. MDD w/ psychotic features
Schizoaffective = not at same time (no mood sx for at least 2 wks while having psychosis)
MDD w/ psychotic features = at same time
