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Psych Block 1 Flashcards

1
Q

Define Delusion

A

Fixed beliefs that cannot be altered despite conflicting evidence

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2
Q

Define Hallucination

A

Perception like experiences that occur w/out external stimulus

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3
Q

How can a provider deduce a PT has disorganized thinking?

A

Inferred by PTs speech-
switching from topic to topic (derailment)
vague or unrelated answers (tangentiality)

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4
Q

Define Catatonic Behavior

A

Decreased in reactivity to the environment
Resistant to instructions or lack of responses
Excessive/purposeless activity w/out cause

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5
Q

Dx criteria for delusional disorder

A

One or more delusions x 1mon or more
Criteria for Schiz has not been met
Function and behavior are not bizarre/odd
Brief manic/depressive episodes
Body dismorphic/OCD doesn’t contribute to Sx

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6
Q

Define Erotomanic Type

Define Grandiose Type

A

Another person is in love with them

Great but unrecognized talent/insight of a great discovery

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7
Q

Define Jealous Type

Define Persecutory Type

A

Delusion spouse/lover is unfaithful

Delusion of being conspired against or obstructed in pursuit of long term goals

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8
Q

Define Somatic Type

Define Mixed Type

A

Delusion involving bodily functions or sensation

No one delusional theme is dominant

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9
Q

Define Unspecified Type

Define a Delusion w/ Bizarre Content

A

Dominant delusion can’t be determined or not described as a specific type

Delusion is bizarre if clearly implausible, not understandable and not derived from ordinary life experiences

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10
Q

Define Delusional Disorder

A

Presence of one delusion for at least a month and unable to meet Schizo Dx
Function not impaired and behavior is not odd
Bipolar Sx considered mild to delusions
Not better explained

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11
Q

What needs to be assessed and considered prior to giving a Dx of Delusional Disorder

A

Sx of Cognition, Depression, and Mania

These are critical distinctions between schizo and other psych d/o

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12
Q

How is Delusional Disorder treated?

A

Prevent harm to self/others
Anti-psychotics- DOC
Antidepressants may be used in conjunction if significant depression exists

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13
Q

Define Brief Psychotic Disorder

A

At least one of:
Delusion, Hallucination, Disorganized Speech that lasts for one day but returns to normal within a month and is not better explained
Essential: sudden onset of one positive psychotic Sx

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14
Q

How is Brief Psychotic Disorder treated?

A

Prevent harm to self or others
Full medical eval and brain imaging considered in 1st episodes of psychosis
Anti-psychotics- DOC
Antidepressants can be used in conjunction

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15
Q

Define Schizophrenia

To make a Dx, what is required?

A

Range of cognitive, behavioral and emotional dysfunction w/ no single one being pathognomonic
Dx requires resence of delusion or hallucinations in absence of mood episodes

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16
Q

If a Dx of ASD/childhood communication disorder is made, it’s only made if ?

A

Prominent delusions or hallucinations are present in addition to schizophrenia Sx

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17
Q

What are the characteristics Sxs of schizophrenia?

A Dx requires ?

A

Must have 2 of 5, most of the time, for at least 1mon:
Delusions
Hallucinations
Disorganized speech
Disorganized behavior/catatonia
Negative Sx- Diminished emotional expression/avolition
Decreased level of function in one area of life

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18
Q

What are the suicidal risks of schizophrenic PTs?

A

5-6% of PTs die by suicide
20% attempt
Sometimes is a response to command hallucinations
Remains high throughout life

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19
Q

What is the Tx plan for Schizophrenia PTs?

A

Prevent harm to self or others
Medical eval and imaging during first psychosis episode
Anti-psychotics- DOC
Antidepressant may be used in conjunction

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20
Q

Define Insomnia

A

Unhappy w/ quantity or quality of one of:
Cant get to sleep
Cant stay asleep

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21
Q

When is Insomnia clinically significant

A

3 nights a week for at least 3mon and with adequate opportunity to sleep

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22
Q

What is the essential feature of insomnia

A

Unsatisfactory quantity/quality of sleep with getting to/staying asleep that frequently presents w/ non-restorative sleep w/ daytime impairment and night time difficulty

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23
Q

What are the non-pharmacological methods for treating insomnia?

A

Cognitive therapy- as effective as Zolpidem w/ benefits sustained 1yr post-treatment
Sleep hygiene

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24
Q

What are the pharmacological methods for treating insomnia?

A 
Diphenhydramine
Hydroxyzine
Lorazepam
Zolpidem- risk of amnesia
Zaleplon
Eszopiclone
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25
Q

Define Hypersomnolence Disorder

A

Excessive sleepiness despite 7hrs of sleep and one of:
Recurrent periods of day sleep
Prolonged non-restorative sleep of 9hrs
Difficulty being fully awake after abrupt awakening
3x/wk for 3mon

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26
Q

Hypersomnolence disorder may also present with what odd Sx?

A

Automatic behavior- driving for miles w/out memory
Long daytime napes
Sleep that develops over time VS in attacks

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27
Q

How is hypersomnolence disorder treated?

A

Encourage hygiene
Evaluate/treat comorbidities
Refer to sleep medicine specialist

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28
Q

Define Narcolepsy

A

Recurrent irrepressible need to sleep, lapsing into sleep or napping in the same day
3 x/wk x 3mon with one of:
Cataplexy
Hypocretin deficiency
Polysomnography showing dec sleep latency

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29
Q

Define Cataplexy

A

PT is awake and aware of brief episodes of sudden, bilateral loss of muscle tone precipitated by emotions

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30
Q

What must be present for PTs to meet Criterion B1 of Cataplexy?

A

Triggered by laughter/joking
Must occur a few times/mon
Not confused as weakness/after triggers (stress, anxiety)

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31
Q

How is Narcolepsy treated?

A

Stimulants- dextramphetamine sulfate

Modafinil- side effect of HA and anxiety, less abuse risk

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32
Q

What are the criteria to be met for a Dx of Obstructive Sleep Apnea Hypopnea

A

Evidence of 5 obstructive apneas/hr of sleep and either:
Snoring, gasping, breathing pause
Daytime sleepiness/fatigue
Evidence of 15 apneas/hr regardless of Sxs

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33
Q

Define Obstructive Sleep Apnea Hypopnea

A

Repeated episodes of upper airway obstruction during sleep most commonly a breathing related sleep disorder

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34
Q

What must be paid specific/particular attention to in Obstructive Sleep Apnea Hypopnea?

A

Occurring in association to snoring/breathing pauses

Findings that inc risk of Dx

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35
Q

How is Obstructive Sleep Apnea Hypopnea treated?

A

Aimed at Sx resolution and reducing comorbid conditions

PAP or dental device to reduce obstruction/inc oxygenation

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36
Q

Define Circadian Rhythm Sleep-Wake Disorder

A

Sleep disruption related to altered rhythm leading to excessive sleepiness

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37
Q

What are the prominent features of Circadian Rhythm Sleep-Wake Disorder?

A

Sleep onset insomnia
Difficult waking
Excessive early day sleepiness

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38
Q

What do PTs with Circadian Rhythm Sleep-Wake Disorder exhibit when they’re allowed to set their own schedules?

A

PTs w/ delayed sleep phase type exhibit normal sleep quality and duration for their age range

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39
Q

What is the treatment for Circadian Rhythm Sleep-Wake Disorder

A 
Reorganization of rhythm
Improve sleep hygiene
Melatonin 
Zolpidem
Benzodiazepine
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40
Q

Define Restless Leg Syndrome

A

Urge to move legs due to uncomfortable sensation with inc urge during rest AND urge to move is releived by movement AND urge worsens in evening/only in evening

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41
Q

How is Restless Leg Syndrome treated?

A

Some behavior therapies
Avoid aggravating factors
Fe replacement

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42
Q

What pharmacetuical therapies can be used for chronic Restless Leg Syndrome?

A

Dopamine agonist- Ropinirole FIRST LINE
Gabapentin
Low dose benzo- Clonazepam

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43
Q

Define Substance/Medication Induced Sleep Disorder

A

Sleep disurbance with both:
Starts after new medication
New med is capable of disurpting sleep
Doesn’t happen exclusively during delirium

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44
Q

What hand out/paper can PTs fill out to rate their sleep issues?

A

Epworth Sleep Scale

STOP-BANG Sleep Apnea

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45
Q

What does STOP-BAND stand for?

A

Snore
Tired
Observed breathing cessation
Pressure, treatment for HTN

BMi +35kg
Age +50
Neck >16”
Gender Male

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46
Q

Criteria of Bipolar 1

A

Elevated mood for 1 week or needing hospitalization
At least 3 of: I STAGED
Ideas Sleep Talkative Activities Goal Esteem Distractability
Severe impairment needing hospitalization/psychotic features
No effects of a substance

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47
Q

Criteria of Bipolar 2

A

Elevated mood for 4 days
At least 3 of: I STAGED
Ideas Sleep Talkative Activities Goal Esteem Distractability
Uncharacteristic behavior change observable by others
No hospitalization/Substances

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48
Q

What are the big/key word differences between Bipolar 1 and 2?

A

1= 1wk or needing hospitalization, severe impairment

2= 4 days, not severe enough for admission

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49
Q

Simply put, how can a Dx of Bipolar 1 be made?

A

Manic episode not related to something else= Dx since the essential feature is the manic episode

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50
Q

Characteristics of Bipolar 1

A 
No depression/hypomania
"Top of the world"
Rapidly shifting emotions
Delusional level of self esteem
Dec need for sleep- COMMON
Resistant to efforts of Tx
15x higher Suicide risk of GenPop
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51
Q

What is the acute management of Bipolar 1

A

Valproic Acid- broader safety index
Lithium- risky, x S/e/Interaction
2nd generation antipsychotic +/- Benzos- GREAT for acute management/rapid cyclers

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52
Q

What is the long term management of Bipolar 1 AND Bipolar 2?

A 
First Line- stay on SAME meds that controlled acute S/Sx
Second line- Lithium- dec SIs
Valproate
Quetiapin
Lamotrigine
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53
Q

Simply put, how is a Dx of Bipolar 2 made?

A

Hypomanic episode and depressive episode= Dx

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54
Q

Bipolar 2 Characteristics

A

Recurring mood episodes- at least one depressive, one hypomanic
Typically- major depressive w/out complaint
High suicide risk, HIGHER lethality than BP1

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55
Q

How is Bipolar 2 treated?

A

Same as Bipolar 1:
Valproic Acid- broader safety index
Lithium- risky, x S/e/Interaction
2nd generation antipsychotic +/- Benzos- GREAT for acute management/rapid cyclers

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56
Q

Define MDD

A 
Depressed mood or loss of interest/pleasure PLUS four x 2 wks:
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
SI/HI
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57
Q

What is the common presenting complaint of MDD?

What Sx is more rare but it’s presence signifies a severe case?

A

Fatigue or Insomnia

Psychomotor Sxs

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58
Q

What is unique about MDDs suicide Hx?

What are the other risk factors that can magnify MDD?

A

Most completed attempts are not preceded by failed attempts

Male, alone, single, feeling hopeless
Presence of borderline personality d/o= huge inc risk

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59
Q

What are the variations of MDD?

A 
Melancholic depression
MDD w/ seasonal onset
MDD w/ peripartum onset
Dysthmia
Premenstrual dysphoric d/o
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60
Q

What is the non-pharmacologic treatment methods for MDD?

A

CBT- key to good plan for depressed PTs
Electroconvulsive therapy
Phototherapy

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61
Q

When is electroconvulsive therapy considered for MDD PTs?

A 
Meds can't be used
Extreme suicide risk
Memory disturbance
HA
Causes generalized seizures
Works best for severe depression
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62
Q

What meds are used for MDD?

A

SSRIs

SNRI- benefit of pain control

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63
Q

What is used for PTs with MDD and sexual dysfunction?

A

PO phosphodiesterase 5 inhibitors- Sildenafil

Adjunct of Buproprion

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64
Q

What med is added on to PTs with MDD but have acute MI or unstable angina?

A

Sertraline

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65
Q

What are the risks of TCA use in MDD Tx?

A

Use w/ caution in cardiac PTs

Lowers seizure threshold

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66
Q

When are MAOIs used for MDD Tx?

A

Third in line if at all

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67
Q

When are stimulants used in Tx of MDD?

A

Effective short term Tx or refractory depression

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68
Q

What are the next steps in MDD Tx if initial response to meds is poor?

A

Reassess Dx

Trial of second meds after appropriate wash out period

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69
Q

What adjuncts can be given to MDD PTs going through wash out periods prior to Rx of second medication?

If you’re at this point of treatment, what is considered?

A

Lithium
Buspirone
Thyroid hormone

Consider specialist help and taper when coming off med

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70
Q

A consideration for full dosage indefinitely for MDD PT if what criteria is met?

A

First episode before 20 or after 50
Over 40 w/ 2 episodes
One episode after 50
3 episodes over lifetime

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71
Q

Define Persistent Depressive Disorder

A

Depressed mood most of the day, more days than not lasting for 2yrs plus two:
Appetite, sleep, energy, self esteem, concentration or hopelessness
No remission of 2mon
No mania, hypomania, cyclothymia

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72
Q

What is the essential feature of Persistent Depressive Disorder?

A

Depressive mood for 2yrs

Sx are a part of daily life and limit them from seeking help

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73
Q

What is the treatment plan for Persistent Depressive Disorder

A

Treat as MDD

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74
Q

What questionnaire can be filled out by PTs w/ suspected Persistent Depressive Disorder

A

Patient Health Questionnaire 2

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75
Q

Define Obsessions

A

Recurrent and persistent thoughts, urges or images that are experienced, intrusive and unwanted

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76
Q

Define Compulsion

A

Repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly

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77
Q

What is the criteria for a PT to have an Obsession?

A

Recurrent/persistent thoughts/urges/images that are intrusive/unwanted and cause anxiety and attempts to ignore/suppress the unwanted w/ another thought/action

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78
Q

What is the criteria for a PT to have a Compulsion?

A

Repetitive behavior/mental act done in response to an obsession/according to rules
Acts aimed at preventing/reducing anxiety/stress or behaviors not realistically connected that are time consuming, clinically significant or impairing function

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79
Q

What specifications have to be made with OCD?

A

Good/fair insight- thoughts are not/probably not true
Poor insight- probably true
Absent insight/delusional- convinced they are true

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80
Q

What is the characteristic feature of OCD?

A

Presence of obsession and compulsions

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81
Q

Individuals with OCD tend to have ?

A 
Dysfunctional beliefs
Inflated sense of responsibility
Overestimates threats
Perfectionists
Need to ontrol thoughts
30% have a tic in lifetime
Common in males
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82
Q

How prevelant is suicide in OCD PTs?

A

SI for half of PTs

Attempts for 1/4 of PTs

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83
Q

What are the non-pharmacologic treatments for OCD?

A

Systemic desensitization

CBT

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84
Q

What are the pharmacologic options for treating OCD?

A

SSRI

Clomipramine- TCA

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85
Q

Define Body Dysmorphic Disorder

A

Perceived defects in physical appearance not observable to others
PT has performed repetitive behaviors/mental acts in response to concerns

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86
Q

What are the most common areas of concern in body dysmophic disorder?

A

Skin
Hair
Nose

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87
Q

Define Nidus

A

Area of concern in body dysmorphic disorder

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88
Q

What are some common repetitive behaviors seen in body dysmorphic disorder?

A 
Comparison
Checking mirrors
Excessive grooming
Camouflaging
Seeks reassurance
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89
Q

What is the suicide prevalence in body dysmorphic disorder?

A

High in adults and adolescents

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90
Q

What are the non/pharmacologic treatments for body dysmorphic?

A

Non- therapy
Pharm- SSRIs
Clomipramine- TCA

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91
Q

Define Hoarding Disorder

A

Difficulty discarding possessions
Perceived need to save item
Distress w/ discarding
Accumulation of possessions that congests/clutters living areas

92
Q

What is the essential feature of hoarding disorder?

A

Long standing difficulty discarding items regardless of value that is not a transient issue

93
Q

How is Hoarding Disorder treated?

A

Difficult, CBT and SSRI

94
Q

Define Trichotillomania

A

Hair pulling disorder most commonly in scalp, eye brow and eye lid area

95
Q

What are the non-pharmaceutical ways for treating Trichotillomania

A

Biofeedback
Desensitization
Habit reversal

96
Q

What are the pharmaceutical ways for treating Trichotillomania

A 
In conjunction w/ Derm:
Topical steroids
Hydroxyzine
Antidepressants
Antipsychotics
97
Q

Define Excoriation

A

Skin picking disorder usually in face, arms and hands

98
Q

How is Excoriation treated?

A

CBT and habit reversal
Fluoxetine
Naltrexone

99
Q

Define Somatic Sx

A

Sx associated w/ somatic nervous system

Pain, tremor, fatigue, paralysis, SoB

100
Q

Define Somatization

A

Physical Sx that mimics a dz that isn’t there

Psychological distress felt in physical form

101
Q

What is the criteria for Somatic Symptom Disorder

A

One somatic Sx w/ disruption to normal life
Excessive thought/feelin/behavior with at least one of:
Thoughts OOPT seriousness
High anxiety about Sx
Excessive time devoted to Sx
State of Sx continuously present

102
Q

How is Somatic Symptom Disorder categorized into Mild, Moderate or Severe?

A

Mild- One criterion
Mod- two or more criterion
Severe- two or more criteria plus multiple somatic complaints, or one severe Sx
(persistent, anxiety, time)

103
Q

What is the treatment plan for Somatic Symptom Disorder?

A

Non-Pharm: Social/Peer support
Pharm: Refractory cases respond to SSRI/SNRI
Don’t use medications to replace appointments

104
Q

Define Illness Anxiety Disorder

A

Worried they MAY have/will get a serious illness w/ or w/out somatic Sxs
High anxiety about health and excessive health related behavior x 6mon

105
Q

How is Illness Anxiety Disorder treated?

A

Same as Somatic Sx Disorder- therapy, education and support

106
Q

Define Conversion Disorder

A

One Sx of altered voluntary motor/sensory function

Objective evidence of incompatibility between Sx and neuro disoder

107
Q

What are the 3 criteria for Conversion Disorder symptoms?

A

Motor- weak/paralysis, tremors, abnormal posturing, speech changes
Sensory- abnormal sensation, vision/hearing changes, globus sensation
Could mimic seizure, syncope or coma

108
Q

How is Conversion Disorder treated?

A

Non-Pharm- hypnosis

Pharm- none really help

109
Q

Define Factitious Disorder

A

Falsified S/Sx or induced injury/dz with identified deception presenting them self as affected
Deception evident w/out sings of secondary gain

110
Q

How is Factitious Disorder treated?

A

Early Psych- conjoint confrontation, biofeedback, self-hypnosis

111
Q

Define Specific Phobia

A

Fear/anxiety OOPT about specific object/thing that provokes immediate fear/anxiety and occuring for +6mon

112
Q

How are specific phobias treated?

A 
Behavioral: desensitization
BCT- combo of this and Rx is better than monotherapy
SSRI/SNRI
Gabapentin
Propranolol- performance anxiety
113
Q

Define Social Anxiety Disorder

A

Fear OOPT about social situation where they’re exposed to scrutiny and expressing anxiety Sx will be negatively evaluated

114
Q

What odd characteristics can PTs w/ Social Anxiety Disorder show?

A

Inadequately assertive, submissive or highly controlling

115
Q

How is Social Anxiety Disorder treated?

A 
Desensitization
CBT in combo w/ meds
SSRI/SNRI
Gabapentin
Propranolol- performance anxiety
116
Q

Define Panic Disorder

A

Unexpected panic attack w/ 4 associated Sxs that are not culturally normal- CHASTS
CC STANDS PDF
Within the last month an attack was followed by: Worrying about more attacks or maladaptive change in behavior

117
Q

How is Panic Disorder treated?

A

Relaxation training
Desensitization- can work as well as meds
CBT w/ med combo
Anti-Depressants are DOC- SSRI/SNRI/TCA
Benzo- acute management
Propranolol- improves peripheral Sx w/out impacting motor/cognitive performance

118
Q

Define Agoraphobia

A 
OOP Anxiety in 2 of 5 situations and avoids them due to difficult escape or limited help/companion
Public transportation
Enclosed areas
Open areas
Being out of the home
Standing in lines
119
Q

How is Agoraphobia treated?

A

Peer support- groups are helpful
SSRI/SNRI
Gabapentin

120
Q

Define Generalized Anxiety Disorder

A

Excessive worry about multiples things, more days than not, for more than 6mon and worry is difficult to control w/ 3 or more Sx (one Sx of bang);
FIRMS DC
Fatigue Irritable Restless Muscle tension Sleep disturbed Difficulty Concentrating

121
Q

How is Generalized Anxiety Disorder treated

A 
Relaxation/Desensitization
CBT
Antidepressants- Fist line treatment, can be anxiogenic
Benzo- avoid if possible
Buspirone
Gabapentin
Propranolol
122
Q

What is the anxiety screening tool?

A

GAD-7

Screening tool, not Dx aid

123
Q

What makes up the Psych Interview

A 
CC
HoPI
Mental Status Exam
AMSIT
Further eval
124
Q

What is the acronym for conducting a mental status exam

A 
AMSIT
Appearance, behavior
Mood
Sensorium
Intelligence
Thoughts
125
Q

How is a PTs attention assessed during an interview?

A

Serial 7s

Spelling backward

126
Q

How is a PTs intelligence/cognition or higher cognitive functions assessed during an interview?

A

Calculating ability

Proverb interpretation

127
Q

What is assessed when analyzing a PTs thoughts, perceptions, judgement, or insight during a psych interview?

A 
Circumstantialities
Derailment
Flight of ideas
Neologisms
Incoherence
Blocking
Confabulation
Perseveration
Echolalia
Clanging
128
Q

How is a PTs insight/judgement assessed during an interview?

A

Insight:
Parable interpretation
Interpret events of personal Hx

Judgement:
Constructional ability- clock/figure drawing

129
Q

What labs/rads can be used in the psychiatric interview?

A

Labs- heavy metals, toxins, infection
EEG
UDS- urine drug screen

130
Q

What psych tests can be performed?

A 
IQ test
PHQ-2
PHQ-9
GAD-7
ESS
ADHD questionnaire
131
Q

What are the EPS side effects of SSRIs?

A

Akathisia
Dystonias
Parkinsonian syndrome

132
Q

Define Serotonin Syndrome

A

Triad of abnormalities:
Cognitive effects- CANA
Neuromuscular- MRHT
Autonomic dysfunction- HHDT

133
Q

How is Serotonin Syndrome treated?

A

With drawl of agent and supportive care for anxiety/seizures w/ Benzos

134
Q

What are the top 4 Sx of each part of the Serotonin Syndrome triads?

A

Cognitive- confusion, agitation, coma, anxiety

Neuromuscular- myoclonus, hyperflexia, rigidity, tremor

Autonomic- hyperthermia, diaphoresis, tachycardia, HTN

135
Q

Which SSRI is safe for abrupt d/c due to it’s long half life?

A

Fluoxetine

136
Q

Which SSRI has an FDA warning on it for cardiac reasons and which med doesn’t have that warning?

A

QT prolongations w/ Citalopram at doses higher than 40mg/day

Escitalopram- no warning

137
Q

What are the two main SNRIs

A

Duloxetine

Venlafaxine

138
Q

What are the NDRIs

A

Bupropion- less sex dysfunction

139
Q

What are the Serotonin Receptor Antagonists

A

Trazodone
Mirtazapine
Nefazodone

140
Q

When are specific SSRIs avoided?

A

Paroxetine- over weight
Citalopram- QT prolongation
Fluoxetine/Sertraline- aggitation, insomnia, pregnancy
Paroxetine- elderly

141
Q

When are Circumstantialities usually seen?

When is Derailment commonly seen?

A

Common in pt’s with obsessions

Common in schizophrenia/mania/psychosis

142
Q

Flight of Ideas are common in

Confabulation is commonly seen in

A

Mania

amnesia

143
Q

Incoherence is commonly seen in ?

Echolalia is commonly seen in ?

A

schizophrenia, 24hr cable news channels

repetition of words and phrases - Autism

144
Q

All meds classified as antidepressants increase ?

A

Concentration of NorEpi, Dopamine and/or Serotonin

145
Q

What are the 3 ways antidepressants increase neurotransmitters?

What pregnancy category do they fall in?

A

Inhibit re-uptake
Block degredation
Increase release

Most are Category C

146
Q

Where is serotonin released from?

Where does serotonin re-uptake occur?

A

Raphe neurons that project into limbic structures

Into presynaptic neuron

147
Q

What are the 6 common SSRIs?

A 
FF SPEC
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
148
Q

What are the adverse effects of taking SSRIs

A 
GI- nausea, diarrhea, constipation
CNS: agitation, tremor, panic
Sexual Dysfuntion
Serotonin Syndrome
EPS- akathisia, dystonia, parkinsonian Sx
149
Q

What SSRIs are most activating?

Who needs to avoid these and when are they taken?

A

Fluxetine Sertraline
Avoid PTs w/ sleep difficulty
Take in the morning

150
Q

What SSRIs are most sedating?

What is the side effect of this group?

A

Paroxetine- worst weight gain

Fluvoxamine

151
Q

All SSRIs have reports of EPS side effects, but which one has the most reports?

A

Paroxetine

152
Q

What are the common side effects of SNRI?

A 
SHINS
Somnolence
HA
Insomnia
Nausea
Sex dysfunction,
153
Q

What are the cautions/warning of TCA use?

A

DC SAP
Life threatening
Delirium Coma Seizure Arrhythmia Psychosis

154
Q

What type of PT should not be given TCAs?

A 
Suicidal ideations
Cardiovascular issues
Close angle glaucoma
Urinary retention
Prostate hypertrophy
155
Q

What are the adverse effects of TCAs?

A

Anticholinergic effect- dry mouth, urine retention, constipation, blurred vision and will worsen BPH

156
Q

TCA dry mouth side effect is linked to ?

A

Weight gain due to tendency to drink caloric beverages

157
Q

PTs with which cardiovascular issues can take TCAs with caution?

A

Ischemic heart disease
Arrhythmia
Conduction disturbance

158
Q

What are the adverse effects of taking Bupropion

A

HIIND
HA, Insomnia, Irritability, N/V, Dec appetite
Less sex dysfunction than other anti-depressants

159
Q

What PTs are contraindicated to use Bupropion?

A

Seizures
Hx of anorexia/bulemia
Use/withdrawing from Benzo or ETOH

160
Q

Function and use of Trazodone

A

Serotonin Receptor Agonist

Depression and Insomnia

161
Q

Function and use of Mirtazapine

A

Depression w/ SSRI but has profound sedative effect

162
Q

Function and use of Nefazodone

A

Anxious depression or when SSRIs cause too much sex dysfunction
Black Box warning- liver failure

163
Q

What is taken into considereation when selecting an antidepressant

A

Previous response of PT/Family to antidepressants
Side effects
Interactions
Comorbid conditions

164
Q

How long is an antidepressant taken before it can be considered a failure?

A

Full therapeutic dose for 2-8wks or up to 12wks

165
Q

Response and remission while taking antidepressants means ?

A

50% reduction of Sx

166
Q

Vortioxetine us is avoided with PTs with what primary concern?

A

Nausea

167
Q

Avoid Mirtazapine in what PTs?

A

Obese

Hyperlipidemia

168
Q

What are the 3 phases of antidepressant therapy?

A

Acute- resolve Sx
Continuation- Sx in remission w/ full dose therapy
Maintenance- long term therapy at full dose in high risk PTs to Whprevent relapses

169
Q

When is depression classified as treatment resistant?

A

Two or more agents from different classes have been tried

170
Q

What medications can be used as augmentation therapy in antidepressants?

A

Lithium- treatment resistant depression
Buspirone
Atypical antipsychotics
Electroconvulsive therapy

171
Q

Which antidepressants are linked with pregnancy risks?

A

Fluoxetine- low birth weight

Paroxetine- heart defects

172
Q

What are the two generations of antipsychotics available for treatment?

A

First Gen- typical

Second gen- atypical

173
Q

Pharmacotherapy selection of antipsychotic depends on ? criteria?

A 
PTs previous experience with antipsychotic
Adverse events
Concomitant conditions
Medicine interactions
PTs preferences
174
Q

What are the typical antipsychotics?

What are the atypicals?

A

Cant Have Lucid Memories Try da xene

CRAPOLA IZ

175
Q

What does the APA recommend when it comes to prescirbing antipsychotics?

A

Use Atypical first due to less EPS risk
PTs w/ preference or +Hx w/ typical may use them first
Max treatment may take 6mon
After treatment is observed, maintain for 6mon

176
Q

What are the adverse reactions of antipsychotics?

A

Dystonia
Tardive Dyskinesia
Akathesia- most common EPS
Sex dysfunction

177
Q

What is the black box warning of antipsychotics?

A

Inc mortality in elderly PTs w/ dimentia

178
Q

Which antipsychotics are low potency typicals?

A

Chlorpromazine IV or PO

Thioridazine PO

179
Q

Which antipsychotics are high potency typicals?

A

Trifluoperazine PO
Fluphenzaine IM
Haloperidol IV IM PO

180
Q

Why were atypical/2nd generation antipsychotics developed?

A

Reduce EPS, tardive dyskinesia and improved efficacy for positive Sx (except Clozapine)

181
Q

Which second generation antipsychotics are PO, IV or IM?

A

PO- all
IV- Aripi, Olanz
IM- Risper, Paliperi, Zipra

182
Q

Most antipsychotics are pregnancy category ?

What is the catch though?

A

C

But, risk of EPS signs and withdrawl in neonates whose mother used antipsychs during 3rd trimester

183
Q

What kind of binding do Benzos exervise?

A

Allosteric

184
Q

Benzos are differentiated by properties, ones that have long half lives have what characteristics?

A

Effects last all day
Less pronounced with drawl Sx
More hangover Sx

185
Q

Benzos are differentiated by properties, ones that have short half lives have what characteristics?

A

Quicker control of Sx
Acute management
Quick tolerance development
Breakthrough Sx- withdraw is common

186
Q

Which Benzos are short acting?

A

TOM
Midazolam
Oxasepam
Triazolam

187
Q

Which Benzos are intermediate acting?

A 
LATE
Lorazepam
Alpazolam
Temazepam
Estazolam
188
Q

Which Benzos are long acting?

A 
CCD FQ
Chlordiazepoxide
Clonazepam
Diazepam
Flurazepam
Quazepam
189
Q

What are the adverse effects of using Benzos?

A

Daytime Hangover- especially in long half life Benzos
Rebound insomnia- if d/c abrupt
Anterograde amnesia- preferred for surgery

190
Q

Benzo treatment periods should be restricted to what time frame?

A

3-4mon as a bridge initiation of chronic therapy

If long term use, tapered for months or even over a year

191
Q

What are the with drawl Sx of Benzos?

A 
Seizure
Psychosis
Disturbed sleep
Tremor
Nauseau
Muscle ache
Anxiety
Depression/confusion
192
Q

What is the rule for using Benzos?

A

Use lowest effective dose of a longer half life for the shorted period possible

193
Q

What is the rescue agent of Benzos?

A

Flumazenil IV- short acting so may need multiple doses to reverse long acting Benzos

194
Q

PTs with ? Hx should not be given Flumazenil

A

Seizures

195
Q

What meds can be used for Bipolar Dz?

A

Lithium
Anticonvulsants- Divalproex, Carbamazepine, Lamotrigine, Topiramate
Antipsychotics- all atypicals for acute mania except Clozapine and Iloperiodone
Benzos- Lorazepam, Diazepam

196
Q

When is Lithium for Bipolar used?

A

Stabilize moods during manic phase

Doesn’t work on rapid cycles- 4 or more/year

197
Q

What drugs are used as adjuncts with Lithium to cover agitation or other Sx?

A

Antipsychotics

Benzos

198
Q

When are antipsychotics d/c in Bipolar PTs?

A

When manic phase is resolved

199
Q

What labs are performed in a pre-lithium work up?

A 
CBC
E=
Renal function
Thryoid function
UA
ECG
Pregnancy
200
Q

Lithium has a narrow index and requires serum blood monitoring between what ranges?

A

0.8-1.2mEq/L

201
Q

What conditions can cause Lithium levels in the body to rise?

A 
Dehydration
Fever
Vomit
Crash diet
Na restricted diets
202
Q

When is Lithium adverse effects most common?

A

During initiation or after dose changes

203
Q

What are the S/sx of Lithium toxicity?

A 
Lethargy
Tremor
Confusion
Neuro/Psych
Seizure
Coma
Cardiac dysrhythmias
Dec thyroid function
204
Q

What is the thyroid risk in long term Lithium use?

A

Hypothyroid and TSH induced toxic goiters

205
Q

What drugs interact w/ Lithium

A

NSAIDs
Thiazides
ACEIs
K Sparing

206
Q

If Lithium toxicity occurs, what steps are taken to help the PT?

A

D/c Lithium
Empty stomach contents
If level was >3mEq/L= dialysis

207
Q

What anticonvulsants can be used in Bipolar?

Why do these need to be used cautiously?

A

Valproic Acid derivatives
Carbamazepine
Lamotrigine
Topiramate

Linked to depression

208
Q

When are Valproic Acid compounds, Carbamazepine and Lamotrigine more effective than Lithium?

A

Rapid Cycling
Comorbid substance abuse
Secondary bipolar d/o
Mixed mania

209
Q

Why are Valproic Acid derivatives used in Bipolar?

A

Acute/prophylactic management

210
Q

When is Carbamazepine used in Bipolar?

A

Acute mania
Maintenance therapy
Added to Lithium for PTs who have responded to monotherapy

211
Q

When is Lamotrigine used for Bipolar?

A

Maintenance therapy

212
Q

Children with a specific phobia may demonstrate ? behavior?

A

Crying
Tantrums
Freezing
Clinging

213
Q

How is the severity of a panic attack measured?

What is the criteria for moderate and less frequent categories?

A

Full Sx- 4+
Limited Sx >4

Moderate: 1/wk x months
Less: two/mon x years

214
Q

What are the two types of Illness Anxiety Disorder?

A

Care Seeking- multiples appts with multiple tests

Care avoidant- avoids hospitals and appointments

215
Q

What are the differences between Illness Anxiety and Somatic Sx Disorder?

A

SSxD/o- Sx is present, usually more than 1, suffering is authentic, Sx state is +6mon

IAD/o- No Sxs or one mild one is present, no real suffering, illness preoccupation present +6mon

216
Q

Define Cyclothymic

A

Chronic fluctuating mood disturbance involving numerous periods of hypomanic Sx and periods of depressive Sxs that are distinct from each other

Dx only made if criteria for MDD, manic or hypomanic episodes are not met

217
Q

Define Schizoaffective Disorder

A

Uninterrupted period of illness

Schizophrenia criteria is met, but there is a major mood episode- pervasive depressed mood

218
Q

Define Schizophreniform Disorder

A

Identical to schizophrenia but duration is different- at least 1 mon but less than 6mon
(episode lasts for 1-6mon)

219
Q

Define Schizotypal disorder

A

Acute discomfort and reduced capacity for close relationships

220
Q

Define Rapid Eye Movement Sleep Behavior Disorder

A

Vocal and/or complex motor behaviors from REM sleep suck as being attacked or escaping from danger while eyes remain SHUT
Upon awakening- individual is awake, alert and orientated

221
Q

Define Non-Rapid Eye Movement Sleep Arousal Disorder

A

Eyes are OPEN with various levels of awareness and motor activity

222
Q

Define Sleep Related Hypoventilation

A

Medical/neuro disorder, medication use or substance use disorder
Morning HA, fatigue, sleepiness

223
Q

Define Central Sleep Apnea

A

Disorder of ventilatory control characterized by sleepiness, insomnia and awakening due to dyspnea with 5 or more apneas per hour
HF, stroke or renal failure

224
Q

When is Bupropion used?

When is Buspropion used?

A 
SOFPS
Smoker
Obese
Fatigue
Psychomotor slowing
Sex Dysfunction

BusPro- augment antidepressant therapy

225
Q

One of the adverse effects of antipsychotics is Dystonia, which means?

Define Tardive Dyskinesia
Define Akathesia

A

Abnormal tonicity, Severe muscle spasm of head, neck and tongue

Involuntary movement of face, mouth, tongue, trunk and limbs

Desire to be in constant motion

226
Q

What are the 4 times to use Propranolol?

A

Specific Phobias
Social Anxiety
Panic attacks
GAD

227
Q

Three drugs better for use than Lithium?

A

CVL

ConVuLse

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