Psych Flashcards
diagnosing GAD in adults
excessive uncontrollable worry about multiple issues for at least 6 months PLUS at least 3 of:
- restlessness, feeling on edge
- fatigue
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
diagnosing GAD in children
same as adults (excessive worry for at least 6 months) but only need 1 additional symptom
*can manifest as need for perfectionism/order with difficulty coping when this is not attainable
for social anxiety disorder, performance only, when would you avoid prescribing benzodiazepines?
- when performance could be impaired by sedation and cognitive effects (eg giving presentation, taking oral exam)
- in patients with substance abuse
treatment of choice for Li toxicity
HD
what 2 meds can be used as adjuncts to antidepressants but never monotherapy?
aripiprazole, Li
what is a normal MoCA score?
> = 26
drug of choice for pediatric depression
fluoxetine
options to manage anti-psychotic induced Parkinsonism
- reducing dose of antipsychotic
- switch to antipsychotic with less potential to cause EPS
- add anticholinergic antiparkinsonian medication (eg benztropine, amantadine) when antispychotic medication is working well and there is concern for destabilizing pt w/ dosage reduction or switching to a new antipsychotic
what form of EPS is irreversible
tardive dyskinesia- lip smacking, tongue protrusion
switching to clozapine is an option
neuropsychiatric symptoms in Cushing syndrome
- depressed or labile mood
- anxiety, panic attacks
- irritability
- insomnia
- memory deficits
- fatigue
- occasionally mania and paranoia
firstline drug for binge eating disorder
SSRI - sertraline
if pt can’t access psychotherapy or prefers meds
what should you counsel patients on before prescribing SSRIs?
- common early side effects (insomnia/sedation, headache, dizziness nausea, anxiety)
- late side effects (sexual dysfunction, weight gain)
- avoid abrupt discontinuation (can lead to SSRI discontinuation syndrome - anxiety, dysphoria, flu-like symptoms)
- response takes 4-6 weeks of continued use
tx MDD with psychotic features
antidepressant plus antipsychotic (ECT if severe suicidality or refusal to eat/drink)
differentiate dependent from borderline personality disorder
dependent pd: submissive. lack mood instability, impulsivity, and self-harm characteristic of borderline
borderline pd: also fear abandonment, but react with rage and demanding behavior.
while other personality disorders can have dependent features, depedent pd is differentiated by predominance of dependent behaviors w/o key personality characteristics of other disorders
nonstimulant options for ADHD
Atomoxetine is treatment of choice, nonaddictive
bupropion, TCAs, alpha-2 agonists
tx panic disorder
maintenance: SSRI and/or CBT
attack: benzo (should not be used in pts with suspected or h/o substance abuse)
which antidepressants have analgesic properties?
SNRIs
TCAs
how does alcoholic hallucinosis differ from DTs
alcoholic hallucinosis has rel stable vital signs, intact orientation. onset 12-48h after last drink.
DTs- confusion, HTN, fever, tachy, diaphoresis. onset 48-96h after last drink
what antidepressant is a/w hypertension
venlafaxine (dose dep)
BP should be monitored, esp at higher doses
treatment for borderline
dialectical behavior therapy
what neurotransmitters does MDMA affect?
incr serotonin, dopamine, NE
what strategies can reduce risk of relapse in schizophrenia?
educating pt and family about sxs and course of schizophrenia can reduce fam sress and conflict;
pts w/ critical, hostile or over involved families have higher risk of relapse
components of suicide risk assessment
Ideation
- passive (wish to die, not waking up)
- active (killing self)
- freq, duration, intensity, controllability
Intent
- strength of intent, ability to control impulsivity
- determine how close pt has come to acting on a plan (rehearsal, aborted attempts)
Plan
- specific details: method, time, place, means, preparations
- lethality of method
- likelihood of rescue
diagnostic criteria persistent depressive disorder (dysthymia)
chronic depressed mood >= 2 years
at least 2 of: appetite change, sleep change, low energy, low self-esteem, poor concentration, hopelessness
diagnostic criteria of adjustment disorder with depressed mood
onset within 3 months of identifiable stressor
marked distress and/or functional impairment
does not meet criteria for another DSM-5 disorder
diagnostic criteria borderline
pervasive pattern of unstable relationships, self image and affects, marked impulsivity with at least 5 of:
- frantic efforts to avoid abandonment
- unstable and intense interpersonal relationships
- markedly and persistently unstable self image
- impulsivity in at least two areas that are potentially self damaging
- recurrent suicidal behaviors or threats of self mutilation
- mood instability
- chronic feelings of emptiness
- inappropriate and intense anger
- transient stress-related paranoia or dissociation
what second gen antipsychotics have the greatest risk of metabolic side effects?
clozapine, olanzapine
which second gen AP have the lowest risk of metabolic side effects?
- aripiprazole
- lurasidone
- ziprasidone
TSH should be measured before and while taking __ (drug)
Lithium
structural abnormalities of orbitofrontal cortex and basal ganglia are a/w ___
OCD
features of cocaine withdrawal
minor physical sxs
- depression, SI
- fatigue, hypersomnia, hyperphagia
- increased dreaming
- impaired concentration
- intense drug craving
firstline maintenance treatments for bipolar disorder
- lithium
- valproate
- quetiapine
- lamotrigine
drugs that can be used to suppress REM sleep (for significant cateplexy)
antidepressants
sodium oxybate
long term side effects of Li
- hyperparathyroidism
- nephrogenic DI
- CKD
- thyroid dysfunction
- Ebstein anomaly
baseline labs before prescribing Li?
- BMP (Cr, BUN)
- UA
- calcium (Li can cause hyperparathyroidism)
- thyroid function tests
- pregnancy test
- ECG if risk factors for CAD (can cause dysrhythmias)
valproate side effect
neural tube defect
what mood stabilizers can cause stevens johnson syndrome
carbamazepine
lamotrigine
what can cause Li toxicity
(decr renal perfusion = decr clearance)
- dehydration
- thiazides, ACEi
- NSAIDs
- tetracyclines
- metronidazole
bupropion is contraindicated in
bulimia
h/o seizures
medical causes of psychosis to r/o in child or adolescent
- SLE
- metabolic or electrolyte disorder
- thyroiditis
- CNS infection
- epilepsy
how long should treatment be continued in remitted single episode of major depression?
6 months
if maintain complete remission at end of continuation phase, can gradually taper and discontinue the antidepressant
When should you maintain 1-3 years of antidepressants?
pts w/ high risk of recurrence:
- 2 or more episodes
- persistent residual depressive symptoms
when should antidepressant maintenance therapy be continue indefinitely?
pts w/
highly recurrent major depressive disorder
-3 or more depressive episodes
chronic episodes
-at least 2 years
severe episodes
strong family history
switching SSRI to or from MAOI requires washout period of _
2 weeks
fluoxetine needs 5 weeks
endocrine causes of anxiety
- hyperthyroid, thyrotoxicosis
- hypoglycemia
- pheo
- carcinoid syndrome
neuro causes of anxiety
epilepsy migraines brain tumors MS Huntington's
metabolic causes of anxiety?
vit B12 deficiency
electrolyte abnormalities
porphyria
respiratory causes of anxiety
asthma, COPD hypoxia PE PNA PTX
cardiac causes of anxiety
CHF
angina
arrhythmia
MI
mnemonic to assess of anxiety is pathologic
SOD: Social or Occupational Dysfunction
features suggestive of psychogenic non-epileptiform seizures
- forceful eye closure
- side-to-side head or body movements
- rapid alerting and reorienting
- memory recall of event
typically occur in front of witnesses
pt ma model behavior after a friend or relative w/ epilepsy
which SSRI can cause dose dependent QTc prolongation?
citalopram (avoid post MI)
what is Trazadone and what is it used for
antidepressant that is extremely sedating, used at low dose for sleep induction
can cause orthostatic HTN, problematic in elderly
what tests should be monitored in pts taking Lithium
kidney and thyroid tests
which second-gen antipsychotic a/w prolonged QTc at higher doses?
Ziprasidone
NMS caused by
antipsychotics
which is reversible, wernicke or korsakoff?
wernicke
cause of Wernicke encephalopathy and symptoms
alcohol use disorder –> thiamine deficiency
classic triad: ataxia, confusion, oculomotor dysfunction
neuropathologic findings in wernicke
mamillary body atrophy
dorsomedial thalamic neuron loss
neuropathologic findings in korsakoff
lesions in anterior and medial thalami and corpus callosum
most common psychiatric complication of MS?
depression
- inflamm changes in brain
- immune system changes
- psychologic reactios to neuro deficits and challenges of living with MS
differentiating parkinson’s disease dementia from lewy body dementia
parkinson’s symptoms predate cognitive impairment by > 1 year
when are benzos less preferred in treating GAD tha persists despite SSRI
h/o using alcohol to self medicate
CJD is aossicated w/ high ___ in CSF
14-3-3 protein
high anti-Hu antibodies are seen in __
paraneoplastic encephalomyelitis (a syndrome a/w small cell lung cancer)
when are high anti-NMDA receptor antibody titers seen
anti-NMDA receptor encephalitis
substances that can induce depression
L-ABC
Levodopa
Alcohol
Beta blockers (esp propranolol)
Corticosteroids
tx options for OCD
CBT
meds:
- first line: SSRI
- can also use Clomipramine (the most serotonin selective TCA)
brain imaging changes in Huntington’s
caudate atrophy
red flags for child abuse
- delayed medical care for injury
- inconsistent explanation of injury
- mult injuries in various stages of healing
-spiral bone fx
- bruising c/w with hand or belt
- cigarette burns
- head injuries
what lab value abnormalities can be seen in NMS
leukocytosis
elevated CK
probable diagnosis of CJD requires
- rapid progression of cognitive decline
- at least two of:
- myoclonus! (often startle)
- visual or cerebellar signs
- pyramidal or extrapyramidal signs
- akinetic mutism - supportive findings from at least 1 diagnostic modaliy
- periodic sharp waves on EEG
- CSF with 14-3-3
- lesions on putamen or caudate nucleus on MRI
tourette’s first line tx? second line?
first line: alpha 2 agonists - guanfacine; clonidine (more sedating)
second line: antipsychotics
normal QT interval
0.4 - 0.44 sec
alzheimer’s affects what region of brain
nucleus basalis of meynert
hemiballismus affects what region of brain
subthalamic nucleus
auditor pathways are in what region of brain
medial geniculate nucleus
kluver-bucy affects what region of brain
amygdaloid nucleus
GAD symptom mnemonic
worry WARTS
worried wound up (irritable), worn out absent minded (concentration) restless tense sleepless
normal QRS interval
80-100 ms
tx acute dystonia
benztropine
diphenhydramine
tx akathisia
benztropine
benzodiazepine
beta blocker (propranolol) (likely works by blocking noradrenergic and serotonergic inputs on dpamine pathways)
tx Parkinsonism
benztropine
amantadine
tx Tardive dyskinesia
valbenazine
deutetrabenazine
REM sleep behavior disorder is highly associated with __
underlying neurodegenerative disorders (parkinson’s, mult system atrophy, dementia with lewy bodies)
___ is effective in treating most REM sleep disorders
clonazepam
Risk factors for restless leg syndrome
- Fe deficiency
- other med comorbidities
- meds (antidepr, antispych, dopamine blocking antiemetics, antihistamines)
what can differentiate between depression vs pseudodementia
depressed pts are aware of their cognitive impairment
essenial components of borderline that differentiate it from histrionic
negative self image
self-destructive behavior (self harm, suicide attempts)
when should you try clozapine for schizophrenia
failed adequaet trials (6 weeks each) of two different antipsychotics
firstline tx schizophrenia
SGA such as quetiapine, risperidone
