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PANCE 2.0 > Psych/Behavioral Health #2 > Flashcards

Psych/Behavioral Health #2 Flashcards

1
Q

Most common adverse effects of TCA’s (Amitriptyline, Nortriptyline, Clomipramine)

A

Anticholinergic effects: dry mouth, constipation, tachycardia, orthostatic hypotension

  • Weight gain, prolonged QT interval
  • Sedation, lowers seizure threshold, SIADH
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2
Q

What are the three indications of overdose of TCA’s?

A

3C’s

  • Cardiotoxicity: wide complex tachycardia
  • Convulsions (seizures)
  • Coma
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3
Q

What can be used for treatment for cardio toxicity of TCA’s?

A

Sodium bicarbonate

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4
Q

What TCA is most useful in obsessive compulsive disorder because it is the most serotonin specific?

A

Clomipramine

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5
Q

When should you use MAO inhibitors for treatment?

A

Refractory depression or refractory anxiety disorders

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6
Q

Adverse effects of MAO inhibitors?

A
  • Orthostatic hypotension (MC)

- Hypertensive crisis after ingesting foods high in tyramine (aged, smoked cheese or meats, red wine, beer, chocolates)

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7
Q

True or False: If MAO inhibitors are combined with SSRI’s, increased risk of serotonin syndrome?

A

True

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8
Q

Adverse effects of Trazodone

A

Sedation (MC)

Priapism

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9
Q

What is serotonin syndrome?

A

Life-threatening syndrome due to increased serotonergic activity in the CNS

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10
Q

Serotonin syndrome MC occurs ______ hours with initiation or change in serotonergic drugs such as SSRI’s, SNRI’s, TCA’s, and MAO’s.

A

within 24 hours (usually 6 hours)

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11
Q

Symptoms of serotonin syndrome

A
  • AMS, agitation, hallucinations
  • Hyperthermia, diaphoresis, blood pressure changes
  • nausea, vomiting, diarrhea
  • clonus, hypertonia (increased DTR), tremor
  • Mydriasis, dry mucus membranes, flushed skin
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12
Q

Treatment for serotonin syndrome

A
  • Prompt discontinuation of drugs
  • IVF, oxygen, Benzodiazepines
  • Cyproheptadine
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13
Q

What is the strongest risk factor for Bipolar 1 disorder?

A

Family history (10x more likely if 1st degree relative has it)

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14
Q

What is the only requirement for Bipolar 1 Disorder?

A

At least 1 manic or mixed episode (elevated expansive or irritable mood at least 1 week with marked impairment of social/occupational function

At least 3: mood (euphoria, labile), thinking (racing, flight of ideas, disorganized, spending sprees), behavior (physical hyperactivity, pressured speech, impulsivity, risk taking)

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15
Q

First-line treatment for Bipolar 1 Disorder

A

Lithium (also decreases suicide risk)

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16
Q

For acute mania, what is the treatment?

A

Antipsychotics (Risperidone or Olanzapine > Haloperidol) or mood stabilizers (Lithium) are most effective

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17
Q

Adverse effects of Lithium

A
  • Hypothyroidism, Nephrogenic Diabetes Insipidus, Hyperparathyroidism
  • Hypercalcemia
  • Hypermagnesemia
18
Q

When should levels be checked after starting Lithium therapy?

A

Prior to starting, get ECG, thyroid function, CBC, and beta-HCG

  • Check levels after 5 days, then every 2-3 days until therapeutic
  • Plasma levels checked every 4-8 weeks
19
Q

Lithium is toxic in pregnancy and may be associated with ______ if taken during the first-trimester

A

Ebstein’s Anomaly

20
Q

What is Ebstein’s Anomaly?

A

Tricuspid valve in the wrong direction and the valve’s leaflets are malformed.

21
Q

When should Lithium NOT be used?

A

With NSAIDs, ACEi, or Thiazide Diuretics

22
Q

What is Bipolar II Disorder?

A

History of at least 1 major depressive disorder + at least 1 hypomanic episode

23
Q

What is a hypomanic episode?

A

Elevated, expansive, or irritable mood < 1 week and does not require hospitalization or have marked impairment of social or occupational function

24
Q

Treatment for Bipolar II Disorder?

A

Lithium (first line) or Atypical Antipsychotics (Risperidone, Olanzapine, Ziprasidone, Quetiapine)

25
Q

What is persistent depressive disorder (Dysthymia)

A

Chronic depressed mood for at least 2 years in adults (1 year in children) that last most of the day, more days than not

-Patient is NOT symptom free for > 2 months at a time

26
Q

Treatment for persistent depressive disorder

A

-Psychotherapy + SSRI/SNRI/TCA/MAO

27
Q

Cyclothymic Disorder is

A

At least 2 years of prolonged, milder elevations and depressions in mood that DO NOT meet criteria for full hypomanic episodes of major depressive episodes

28
Q

Treatment for cyclothymic disorder

A

Lithium or Atypical Antipsychotics

29
Q

When does PMS occur?

A

Luteal phase of the menstrual cycle

30
Q

What is premenstrual dysphoric disorder?

A

Severe PMS with functional impairment where anger, irritability, and internal tension are prominent

31
Q

Name some symptoms of PMDD

A
  • Bloating and fatigue (MC)
  • Breast swelling or pain
  • Headache
  • Changes in bowel habits
  • Irritability (MC)
  • Anxiety, hostility, libido changes
  • food cravings
  • Poor concentration
  • noise sensitivity
  • Loss of motor senses
32
Q

What is the diagnostic criteria for PMDD (what is the normal occurrence of the symptoms)?

A

Symptoms occurring 1-2 weeks before menses (luteal phase) relieved within 2-3 days of the onset of menses, plus at least 7 symptom free days during follicular phase

33
Q

Management of PMDD

A
  • Lifestyle modifications: stress reduction, exercise (most beneficial). Caffeine, alcohol, smoking, salt reduction. NSAIDs, vitamin B6 and E
  • SSRI’s: first line for emotional symptoms
  • Oral contraceptives: Must contain Drospirenone if they do not want to take SSRI’s
34
Q

What is the single strongest predictive factor for suicide?

A

Previous attempt

35
Q

Conduct disorder is

A

persistent pattern of behaviors that deviate sharply from the age-appropriate norms and violates the rights of others and animals

36
Q

Conduct disorder may progress to

A

Antisocial personality disorder

37
Q

What are some symptoms of conduct disorder?

A
  • Aggression to humans and animals
  • Destruction of property
  • Serious violation of rules
  • Deceitfulness or theft
  • MUST BE < 18 years old
38
Q

Treatment for conduct disorder

A
  • Behavioral modification
  • Community and family involvement
  • parent management training (enforcing rules, setting limits)
39
Q

What are some indications of a good prognosis of a patient with conduct disorder?

A
  • Positive relationship with at least 1 parent
  • Adolescent onset of symptoms
  • Female gender
  • High IQ
  • Good academic performance
40
Q

What is oppositional defiant disorder?

A

Child who is generally defiant towards authority but NOT associate with physical aggression, violating others’ rights, or breaking laws

41
Q

Symptoms of ODD

A
  • Angry or irritable mood
  • Argumentative or defiant behavior
  • Vindictiveness (spiteful)
42
Q

Treatment for ODD

A

-Psychotherapy: behavioral modification therapy, teaching parents child management, problem-solving skills, etc.

PANCE 2.0 (62 decks)

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