Psych/Behavioral Med Flashcards
anxiety d.o to know
GAD: 6 mos
panic d.o: >/= 1 mo
phobias
-recurrent, unexpeted panic attacks with at least 1 month or more of worry or avoidant behavior
+/- agorahobia
-sx develop abruptly and reach a peak w.in 10 min
panic disorder
tx for agoraphobia
SSRI
CBT
bipolar related disorders
bipolar I: mostly mania
bipolar II: mostly dpn, hypomania
cyclothymic
hypomania alternating w. long standing dysthymia x 2 years
cyclothymic d.o
squandering savings
destroying relationships
neglecting work
bipolar I
first line tx for bipolar I
lithium
tx for bipolar I
acute mania: lithium, valproate, SGAs
mania maintenance: SGAs, gabapentin, lamotrigine
agitation: haldol, risperidone, benzo
fam/group/CBT
hypomania is defined as
-not severe enough to cause marked impairment in social/occupational functioning
-no hospitalization
-no psychotic features
tx for bipolar II
quetiapine vs olanzapine + fluoxetine
fam/group therapy/CBT
less intense, longer acting form of bipolar
cyclothymia
highs and lows, but never as severe as mania or major dpn
4 types of depressive disorders
mdd
persistent depressive d.o (dysthymia)
premenstrual dysphoric d.o
suicidal/homicidal behaviors
mdd is _ or more of significantly depressed moods
2 weeks
persistently depressed mood w. low self esteem, withdrawal, pessimism, or despair x at least 2 years w. no absence for more than 2 months
persistent depressive d.o (dysthymia)
significant dpn and related sx during the week before menstruation
premenstrual dysphoric d.o
mood d.o, somatic complaints, feeling hopelessness, worthlessness, helplessness
suicidal/homicidal, behaviors
dsm 5 for mdd
5 or more sigecaps >/= 2 weeks, nearly every day - at least one sx is depressed mood or anhedonia
what does sigecaps stand for
sadness
interest/anhedonia
guilt
energy
concentration
appetite
psychomotor activity
suicidality
how do you uptitrate SSRIs
increase dose q 3-4 weeks until sx are in remission
30 yo M feeling down most of the time x 3 years - frequent intruisive thoughts of inadequacy despite success - he tries to overcompensate by taking on more than he can handle, which leads to failure and furthers feelings of inadequacy
persistent depressive d.o (dysthymia)
with dysthymia, the pt never experiences
mania/hypomania
dsm 5 premenstrual dysphoric d.o
-at least 5 sx the final week before onset of menses
-improve w.in a few days after onset of menses -
-resolve in the week post menses
one or more must be present:
-affective lability
-interpersonal conflicts
depressed mood
-anxiety
-decreased interest
PLUS
one or more:
-difficulty concentrating
-lethargy
-change in appetite
-insomina
-overwhelmed
-physical (bloating, breast tenderness etc)
tx for premenstrual dysphoric d.o
-SSRIs continuously vs week prior to menses
-OCP
-diuretics
-SNRI
-GnRH
SNRIs are esp useful for premenstrual dysphoric syndrome when symptoms are mostly
psychological
2 sx of GnRH
bone loss
vasomotor sx
6 rf for suicide
male
older
mdd
active SUD
chronic conditions
recent loss (employment, relationships, death)
acute cognitive dysfxn 2/2 underlying medical condition - reversible
delirium
mc type of hallucination associated w. delirium
visual
pt’s esp high risk for delirium
post surgery w. heart disease or DM
mc presentation of AMS in inpt setting
delirium
mc cause of delirium
etoh abuse
delirium is a common s.e of _
hyperthyroidism
thyroid storm
causes of delirium (7)
UTI
PNA
metabolic changes
CVA
MI
TBI
meds
3 meds associated w. delirium
anticholinergics
benzos
opioids
don’t forget to order this in a febrile pt w. delirium
LP
pharm for agitatiion/psychosis w. delirium
haldol
disorders w. a significant or moderate impairment of cognition or memory that represents a marked deterioration from a previous level of fxn
neurocognitive d.o
mild/moderate neurocognitive d.o are same same
dementia
causes of dementia
alzheimer’s
frontotemporal lobar degeneration
lewy body dz
vascular dz
TBI
SUD
meds
HIV
prion dz
parkinson’s
huntington’s
what are the 2 cognitive exams
MMSE
MoCA
what class of drug may temporarily improve cognitive fxn
cholinesterase inhibitors:
donepezil
galantamine
rivastigmine
2 hallmark bx findings in alzheimer’s
bate amyloid plaquees
neurofibrillary tangles
what type of dementia is characterized by personality changes preceding memory changes
frontotemporal lobar degeneration
what type of dementia is characterized by parkinsonian sx
lewy body
2 mc types of dementia
- alzheimer’s
- vascular dementia
what type of dementia is associated w. arteriosclerotic dz and may involve a sudden decline in mental status
vascular dementia
what dementia is associated w. hallucinations, delusions, gait difficulties, and falls
lewy body
what dementia is associated w. language difficulties, personality changes, and behavioral disturbance
frontotemporal lobar
what type of dementia has a rapid onset and is very rare
creutzfeldt jakob
bx finding of HIV associated dementia
cerebral atrophy
dsm 5 for panic d.o
-3 panic attacks in 3 weeks
-at least one has been followed by at least one month of one or both:
-worry about additional attacks
-maladaptive change in behavior related to attacks
diagnostic criteria for for ptsd
-traumatic event -> acute stress rxn
-sx persist past one month
tx for ptsd
ssri’s
prazosin for nightmares
schizophrenia spectrum
delusional d.o
schizoaffective d.o
schizophrenia
schizophreniform d.o
normally functioning person w. a belief in something that does not exist
delusional d.o
-psychotic d.o characterized by BOTH schizophrenia and a major mood d.o (dpn, bipolar)
-sx may occur at the same time
schizoaffective d.o
psychotic d.o associated w. delusions, hallucinations, disoganized speech, and/or diminished inappropriate emotional expression > 6 months
PLUS
difficulty functioning
schizophrenia
-psychotic d.o involving the sx of schizophrenia > 1 week, < 6 months
-no social/occupational impairment
schizophreniform d.o
common delusions associated w. delusional d.o
non bizarre delusions - beliefs that occur in real life
-poisoning
-stalking
-being loved or deceived
-having an illness
beliefs last > 1 month
tx for delusional d.o
atypical antipsychotics
-olanzapine
-risperidone
45 yo M - hearing things that aren’t there x 2 weeks, severely depressed - hearing things - life is not impaired by hallucinations at this time
schizoaffective d.o
dsm 5 for schizoaffetive d.o
schizophrenia PLUS mood d.0 x 2 or more weeks
tx for schizoaffective d.o
atypical antipsychotics
SSRIs
26 yo M - hearing voices of ppl plotting to kill him - has missed multiple days of work and was recently fired - he is dishevled, incoherent, and has disorganized speech - was normal until 8 months ago
schizophrenia
major psychosis x 6 months or more + difficulty functioning
schizophrenia
dsm 5 for schizophrenia
2 or more of the following x 6 months:
-delusions
-hallucinations
-disorganized speech/thought/behavior
-impaired ADLs
-negative sx
-inability to maintain job/relationships
what are negative sx
blunted affect
poor posture
lack of goal-direct activities/initiatives
tx for schizophrenia
SGAs
clozapine
FGAs
what drugs are most effective for positive sx
FGAs:
haldol
chlorpromazine
thioridazine
loxapine
fluphenazine
what SGA is not first line due to risk for agranulocytosis
clozapine
pharm for tx resistant schizophrenia
clozapine OR SGA
PLUS
benzo/carbamazepine/valproate/lithium
3 s.e of antipsychotics
parkinsonism
neuroleptic malignant syndrome
TD
mc type of hallucination w. schizophrenia
auditory
23 yo M grad student - visual and auditory hallucinations x 2 months - he is able to attend classes but having difficulty focusing - dad has schizophrenia - takes no meds - labs/imaging nl
schizophreniform d.o
dsm 5 for schizophreniform d.o
-major psychosis > 1 week but < 6 mos
-no social/occupational impairment
schizophrenia and schizophreniform are basically same-same, what differentiates them
schizophreniform d.o: > 1 week, < 6 mos
schizophrenia: > 6 mos, social/occupational impairment
tx for schizophreniform d.o
SGAs
resistant: consider lithium, anticonvulsants
types of abuse/neglect
child abuse
domestic violence
elder abuse
sexual abuse
spouse/partner neglect/violence
what type of fx makes you concerned for child abuse
spiral fx
2 types of burns that make you suspect child abuse
doughnut shaped
stocking-glove
child abuse may manifest as
anxiety
aggression
PTSD
dpn/suicide
SUD
poor self esteen
dissociative d.o
paranoid
FTT
t/f: neglect can be considered if a minor is allowed to engage in etoh
t!
definition for domestic violence
any act of violence against family members
child sexual abuse is mc in ages _
and is often done by _
9-12
male known to child
moa for etoh
-increases GABA channel opening
-longterm: downregulation of GABA channels -> inhibitory
-upregulation of NMDA -> excitatory
tx for etoh withdrawal (5)
thiamine
folate
MVI
IVF w. dex
benzos
delirium tremens happens w.in _ hr of etoh withdrawal onset
48-96
4 sx of delirium tremens
autonomic instability
disorientation
hallucinations
agitation
5 addiction medications
disulfram (antabuse)
naltrexone: oral vs extended release
acamprosate
topiramate
gabapentin
what 3 addiction meds decrease desire to drink
naltrexone
topiramate
gabapentin
what addiction med inhibits acetaldehyde dehydrogenase and leads to aversive conditioning
disulfram (antabuse)
what addiction med changes brain chemistry to reduce anxiety, irritability, and restlessness - leads to early sobriety
acamprosate
etoh withdrawal timeline
moa for anxiolytics
increase frequency of GABA channel opening
intoxication vs withdrawal sx of benzos
intoxication: respiratory dpn, hypotn, amnesia, ataxia, stupor/somnolence, coma, death
withdrawal: rebound anxiety, tremor, sz
tx for benzo intoxication vs withdrawal
intoxication: flumazenil (GABA antagonist)
withdrawal: clonazepam (long acting benzo)
moa for cannabis
binds to CB1/CB2 receptors
what drugs are associatd w. simulant related d.o (3)
cocaine
amphetamines
moa for cocaine vs amphetamines
cocaine: block reuptake of DA, NE, 5HT
amphetamines: stimulates DA, NE, 5HT release PLUS decrease reuptake
what are the biogenic amines (3)
dopamine (DA)
norepinephrine (NE)
serotonin (5HT)
tx for stimulant intoxication
antipsychotics
benzos
labetalol
alpha 1 blockers
vitamin C
what pharm promotes excretion of cocaine
vitamin C
never _ a pt w. cocaine intoxication
restrain
risk for rhabdo
pharm for stimulant withdrawal
bupropion
bormocriptine
SSRIs
what 2 drugs are associated w. hallucinogen related d.o
PCP
LSD
pt is extremely aggressive and becomes enraged w. sudden movements or w. loud sounds
PCP
moa for PCP
NMDA antagonist
like ketamine
6 PE findings of PCP intoxication
belligerence
fear
homicidality
psychosis
vertical AND horizontal nystagmus
tachycardia
tx for PCP intoxication (4)
haldol
benzos
low stimulatn environment
restraints
tx for PCP withdrawal
symptomatic
pt wants to hurt himself - freaking out and hallucinating
LSD
moa for LSD
5HT agonist
tx for acute LSD intoxication
haldol
benzos
talk down/supportive counseling
why isn’t LSD associated w. withdrawal
does not affect DA
leading cause of preventable death in US
tobacco
3 meds or tobacco cessation
bupropion
varenicline (chantix)
NRT
which tobacco cessation med has highest success rates
varenicline
esp when used w. NRT
4 sx of inhalant intoxication
belligerence/assault
apathy
blurred vision
coma
tx for inhalant intoxication
supportive
+/- haldol
tx for opioid withdrawal
clonidine
methadone
suboxone - withdrawal if given too early
