Psych Flashcards
Treatment for acute dystonia following new antipsychotic (haloperidol)?
Anti-cholinergic medications such as diphenhydramine
Dissociative disorders
Dissociative Identity Disorder- Childhood trauma, neglect, blackouts, multiple personalities
Dissociative Amnesia- Stressor, loss of memory of stressor
Dissociative Fugue- Stressor, loss of memory of stressor AND TRAVEL
Depersonalization- Teenager, mild stressor, out-of-body experience
What is the difference between kleptomania and petty theft?
Kleptomania- urge to steal something with little value, person will feel guilty afterwards, usually will be same thing each time (fork)
Petty theft- different things each time and the things will be things the person uses
Stage I of Sleep
Theta Waves
Stage II of Sleep
K-complexes and sleep spindles.
Stage III and 4 of Sleep
Delta waves
How long should depression be treated for even if symptoms remove?
6 months then taper off meds (need a few months for brain plasticity and not to return to depression)
Treatment for Post-partum depression
Post-partum depression is diagnosed by depressive symptoms with onset within 4 weeks that do not resolve on their own, and are often accompanied by neglect or abandonment of the child (opposed to actively trying to harm it). It is treated with SSRIs.
Treatment for catatonia
Catatonia is associated with mood disorders (bipolar/depression) and can present with mutism, catalepsy/waxy flexibility, echolalia, echopraxia, and stupor. Treat with Lorazepam.
Treatment for adjustment disorder?
emotional/behavioral response to a recent stressor that is in excess of what you would expect. The symptoms have to start within 3 months, end before 6 months, and cause some form of impairment in the patient’s life.
Tx: reassurance or short term supportive psychotherapy
Side effect of Olanzapine
weight gain and diabetes
Before starting an atypical antipsychotic, what tests must be done?
All atypical antipsychotics require body mass index at baseline then monthly
Fasting glucose and lipid panel at baseline, 3 months, and annually.
Side effect of resperidone
extrapyramidal side effects and galactorrhea/amenorrhea.
Side effect of Ziprasidone
Ziprasidone has been linked to QT prolongation.
Schizo diseases and duration
When evaluating psychotic episodes, duration is key. Less than one month? Brief psychotic disorder. 1 month to 6 months? Schizophreniform. More than 6 months? Schizophrenia.
Diagnosing narcolepsy
Narcolepsy presents as periods of cataplexy, response to loud noises, and awakening refreshed.
Diagnosed w/ polysomnography (sleep study)
It is treated with scheduled naps and amphetamines.
Treatment for Generalized Anxiety Disorder
Psychotherapy (CBT) and SSRI. Start with therapy for mild cases (limited to no functional impairment), meds when function is impaired (fatigued, low productivity, maladaptive behaviors, concurrent depression or substance use)
First psychotic episode management:
An acute psychotic disorder without a clear stressor should be ruled out for acute drug intoxication with a urine drug screen.
What is the treatment for enuresis (bed wetting)?
Life style modification (decrease water intake at night, wet alarms etc)
Desmopressin is the preferred, first line therapy for enuresis that is refractory to life-style modifications and enuresis alarms
2nd line- tricyclic antidepressants (imipramine)
Management of prophylaxis of alcohol withdrawal
Prevent alcohol withdrawal with medium- acting benzo (chlordiazepoxide). Diazepam (valium) is also appropriate
Alcohol withdrawal is treated with benzodiazepines (lorazepam)
Treatment for severe depression during pregnancy.
ECT is safe in pregnancy. Usually reserved for severe, refractory cases of depression. Pregnant woman + severe depression needing hospitalization = ECT.
How long should you wait before adjusting meds for depression and antipsychotics?
Wait 6 weeks before changing depression meds then washout
Wait 24 hrs before changing psychotics, no washout needed
Lithium side effects
Lithium causes hypothyroidism, nephrogenic diabetes insipidus, and Ebstein’s anomaly in utero. It also has a narrow therapeutic index and is metabolized by the kidneys.
Get pregnancy test, creatinine and TSH levels before starting lithium.
Which medication causes seizures upon withdrawal?
Benzodiazepines and alcohol
Treatment for opioid withdrawal?
Opiate withdrawal is NOT a life threatening condition, but it is a painful process to get through.
First line treatments are buprenorphine OR methadone.
Clonidine is helpful adjunctively for autonomic symptoms.
Treatment for body dysmorphic Disorder?
Cognitive behavioral therapy and SSRIs are appropriate therapeutic options for BDD
What is delusional disorder?
fixed false belief - one that is reasonable, but likely not true.
Besides that delusion, person is totally normal.
Treatment for post-partum psychosis?
Active hallucinations and delusions indicate post-partum psychosis, treated with hospitalization, anti-psychotics, and supervised visits with the child until well. This is more about protecting the baby than treating mom
Treatment for PTSD?
psychotherapy + SSRI. Both is better than either one alone.
Avoidant personality disorder
Avoidance of social situations due to underlying feelings of personal inadequacy and social ineptness.
The treatment of choice for any personality disorder is psychotherapy.
Selective serotonin reuptake inhibitors (SSRI) or serotonin-norepinephrine reuptake inhibitors (SNRI) may also be a helpful
Risk factors for aortic dissection
Most common risk factor is hypertension
Other risk factors- smoking, hypercholesterolemia, structural abnormalities such as bicuspid aortic valve, aortic coarctation, connective tissue disorders (Ehler-Danlos syndrome, Marfan syndrome), and Turner syndrome
Treatment of Haemophilus ducreyi chancroid
Single dose of oral azithromycin
Single dose of IM ceftriaxone
Erythromycin 3 times daily for 7 days
Ciprofloxacin twice daily for 3 days
Sex cord stromal tumors
Sertoli cell tumor-
Treatment for Bulimia nervosa
Episodes of binging and purging occurring at least once weekly for 3 months
First-line pharmacological treatment option includes fluoxetine, which has a longer half-life than most antidepressants
Second-line pharmacological treatment options include sertraline, escitalopram, and fluvoxamine
OCD vs OCD personality
Obsessive compulsive personality disorder is characterized by rigidity and preoccupation with details that interfere with functioning, however the person does not find this distressing.
In Obsessive-Compulsive Disorder thoughts and behaviors are intrusive and distressing
Avoidant restrictive food intake disorder (ARFID)
Eating disorder characterized by a disturbance of feeding or eating that leads to significant weight loss, nutritional deficiency, and dependence on enteral supplements
Associated with anxiety disorders, learning disabilities, and pervasive developmental disorders.
Exhibitionistic disorder
Exposing one’s genitalia to others
Fetishistic disorder
Focusing on inanimate objects or specific nongenital body parts
Frotteuristic disorder
Touching or rubbing against an unwilling person
Sexual masochism disorder
Receiving humiliation, bondage, or suffering
Sexual sadism disorder
Inflicting humiliation, bondage, or suffering
Transvestic disorder
Displaying a sexual fetish involving cross-dressing
Voyeuristic disorder
Secretly watching others while naked/undressing or in sexual activity
Neuroleptic malignant syndrome
“Lead pipe” rigidity, tremor, altered mental status, unstable vital signs
Tx: Remove offending agent, supportive care, bromocriptine or dantrolene
Akathisia
Extreme restlessness
Tx: Propranolol
Acute dystonia
Intermittent muscle spasms (eg, torticollis, laryngospasm, oculogyric crisis)
Tx: Diphenhydramine or benztropine
Anti-thyroid stimulating hormone antibodies
Graves’ disease
Anti-thyroid peroxidase antibodies
Hashimoto’s thyroiditis
