Psych Block 1 Flashcards
1
Q
Define Delusion
A
Fixed beliefs that cannot be altered despite conflicting evidence
2
Q
Define Hallucination
A
Perception like experiences that occur w/out external stimulus
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)
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
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
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
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
8
Q
Define Somatic Type
Define Mixed Type
A
Delusion involving bodily functions or sensation
No one delusional theme is dominant
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
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
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
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
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
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
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
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
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
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
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
20
Q
Define Insomnia
A
Unhappy w/ quantity or quality of one of:
Cant get to sleep
Cant stay asleep
21
Q
When is Insomnia clinically significant
A
3 nights a week for at least 3mon and with adequate opportunity to sleep
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
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
24
Q
What are the pharmacological methods for treating insomnia?
A
Diphenhydramine Hydroxyzine Lorazepam Zolpidem- risk of amnesia Zaleplon Eszopiclone
25
Define Hypersomnolence Disorder
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
26
Hypersomnolence disorder may also present with what odd Sx?
Automatic behavior- driving for miles w/out memory
Long daytime napes
Sleep that develops over time VS in attacks
27
How is hypersomnolence disorder treated?
Encourage hygiene
Evaluate/treat comorbidities
Refer to sleep medicine specialist
28
Define Narcolepsy
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
29
Define Cataplexy
PT is awake and aware of brief episodes of sudden, bilateral loss of muscle tone precipitated by emotions
30
What must be present for PTs to meet Criterion B1 of Cataplexy?
Triggered by laughter/joking
Must occur a few times/mon
Not confused as weakness/after triggers (stress, anxiety)
31
How is Narcolepsy treated?
Stimulants- dextramphetamine sulfate
| Modafinil- side effect of HA and anxiety, less abuse risk
32
What are the criteria to be met for a Dx of Obstructive Sleep Apnea Hypopnea
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
33
Define Obstructive Sleep Apnea Hypopnea
Repeated episodes of upper airway obstruction during sleep most commonly a breathing related sleep disorder
34
What must be paid specific/particular attention to in Obstructive Sleep Apnea Hypopnea?
Occurring in association to snoring/breathing pauses
| Findings that inc risk of Dx
35
How is Obstructive Sleep Apnea Hypopnea treated?
Aimed at Sx resolution and reducing comorbid conditions
| PAP or dental device to reduce obstruction/inc oxygenation
36
Define Circadian Rhythm Sleep-Wake Disorder
Sleep disruption related to altered rhythm leading to excessive sleepiness
37
What are the prominent features of Circadian Rhythm Sleep-Wake Disorder?
Sleep onset insomnia
Difficult waking
Excessive early day sleepiness
38
What do PTs with Circadian Rhythm Sleep-Wake Disorder exhibit when they're allowed to set their own schedules?
PTs w/ delayed sleep phase type exhibit normal sleep quality and duration for their age range
39
What is the treatment for Circadian Rhythm Sleep-Wake Disorder
```
Reorganization of rhythm
Improve sleep hygiene
Melatonin
Zolpidem
Benzodiazepine
```
40
Define Restless Leg Syndrome
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
41
How is Restless Leg Syndrome treated?
Some behavior therapies
Avoid aggravating factors
Fe replacement
42
What pharmacetuical therapies can be used for chronic Restless Leg Syndrome?
Dopamine agonist- Ropinirole FIRST LINE
Gabapentin
Low dose benzo- Clonazepam
43
Define Substance/Medication Induced Sleep Disorder
Sleep disurbance with both:
Starts after new medication
New med is capable of disurpting sleep
Doesn't happen exclusively during delirium
44
What hand out/paper can PTs fill out to rate their sleep issues?
Epworth Sleep Scale
| STOP-BANG Sleep Apnea
45
What does STOP-BAND stand for?
Snore
Tired
Observed breathing cessation
Pressure, treatment for HTN
BMi +35kg
Age +50
Neck >16"
Gender Male
46
Criteria of Bipolar 1
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
47
Criteria of Bipolar 2
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
48
What are the big/key word differences between Bipolar 1 and 2?
1= 1wk or needing hospitalization, severe impairment
2= 4 days, not severe enough for admission
49
Simply put, how can a Dx of Bipolar 1 be made?
Manic episode not related to something else= Dx since the essential feature is the manic episode
50
Characteristics of Bipolar 1
```
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
```
51
What is the acute management of Bipolar 1
Valproic Acid- broader safety index
Lithium- risky, x S/e/Interaction
2nd generation antipsychotic +/- Benzos- GREAT for acute management/rapid cyclers
52
What is the long term management of Bipolar 1 AND Bipolar 2?
```
First Line- stay on SAME meds that controlled acute S/Sx
Second line- Lithium- dec SIs
Valproate
Quetiapin
Lamotrigine
```
53
Simply put, how is a Dx of Bipolar 2 made?
Hypomanic episode and depressive episode= Dx
54
Bipolar 2 Characteristics
Recurring mood episodes- at least one depressive, one hypomanic
Typically- major depressive w/out complaint
High suicide risk, HIGHER lethality than BP1
55
How is Bipolar 2 treated?
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
56
Define MDD
```
Depressed mood or loss of interest/pleasure PLUS four x 2 wks:
Sleep
Interest
Guilt
Energy
Concentration
Appetite
Psychomotor
SI/HI
```
57
What is the common presenting complaint of MDD?
What Sx is more rare but it's presence signifies a severe case?
Fatigue or Insomnia
Psychomotor Sxs
58
What is unique about MDDs suicide Hx?
What are the other risk factors that can magnify MDD?
Most completed attempts are not preceded by failed attempts
Male, alone, single, feeling hopeless
Presence of borderline personality d/o= huge inc risk
59
What are the variations of MDD?
```
Melancholic depression
MDD w/ seasonal onset
MDD w/ peripartum onset
Dysthmia
Premenstrual dysphoric d/o
```
60
What is the non-pharmacologic treatment methods for MDD?
CBT- key to good plan for depressed PTs
Electroconvulsive therapy
Phototherapy
61
When is electroconvulsive therapy considered for MDD PTs?
```
Meds can't be used
Extreme suicide risk
Memory disturbance
HA
Causes generalized seizures
Works best for severe depression
```
62
What meds are used for MDD?
SSRIs
| SNRI- benefit of pain control
63
What is used for PTs with MDD and sexual dysfunction?
PO phosphodiesterase 5 inhibitors- Sildenafil
| Adjunct of Buproprion
64
What med is added on to PTs with MDD but have acute MI or unstable angina?
Sertraline
65
What are the risks of TCA use in MDD Tx?
Use w/ caution in cardiac PTs
| Lowers seizure threshold
66
When are MAOIs used for MDD Tx?
Third in line if at all
67
When are stimulants used in Tx of MDD?
Effective short term Tx or refractory depression
68
What are the next steps in MDD Tx if initial response to meds is poor?
Reassess Dx
| Trial of second meds after appropriate wash out period
69
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?
Lithium
Buspirone
Thyroid hormone
Consider specialist help and taper when coming off med
70
A consideration for full dosage indefinitely for MDD PT if what criteria is met?
First episode before 20 or after 50
Over 40 w/ 2 episodes
One episode after 50
3 episodes over lifetime
71
Define Persistent Depressive Disorder
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
72
What is the essential feature of Persistent Depressive Disorder?
Depressive mood for 2yrs
| Sx are a part of daily life and limit them from seeking help
73
What is the treatment plan for Persistent Depressive Disorder
Treat as MDD
74
What questionnaire can be filled out by PTs w/ suspected Persistent Depressive Disorder
Patient Health Questionnaire 2
75
Define Obsessions
Recurrent and persistent thoughts, urges or images that are experienced, intrusive and unwanted
76
Define Compulsion
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
77
What is the criteria for a PT to have an Obsession?
Recurrent/persistent thoughts/urges/images that are intrusive/unwanted and cause anxiety and attempts to ignore/suppress the unwanted w/ another thought/action
78
What is the criteria for a PT to have a Compulsion?
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
79
What specifications have to be made with OCD?
Good/fair insight- thoughts are not/probably not true
Poor insight- probably true
Absent insight/delusional- convinced they are true
80
What is the characteristic feature of OCD?
Presence of obsession and compulsions
81
Individuals with OCD tend to have ?
```
Dysfunctional beliefs
Inflated sense of responsibility
Overestimates threats
Perfectionists
Need to ontrol thoughts
30% have a tic in lifetime
Common in males
```
82
How prevelant is suicide in OCD PTs?
SI for half of PTs
| Attempts for 1/4 of PTs
83
What are the non-pharmacologic treatments for OCD?
Systemic desensitization
| CBT
84
What are the pharmacologic options for treating OCD?
SSRI
| Clomipramine- TCA
85
Define Body Dysmorphic Disorder
Perceived defects in physical appearance not observable to others
PT has performed repetitive behaviors/mental acts in response to concerns
86
What are the most common areas of concern in body dysmophic disorder?
Skin
Hair
Nose
87
Define Nidus
Area of concern in body dysmorphic disorder
88
What are some common repetitive behaviors seen in body dysmorphic disorder?
```
Comparison
Checking mirrors
Excessive grooming
Camouflaging
Seeks reassurance
```
89
What is the suicide prevalence in body dysmorphic disorder?
High in adults and adolescents
90
What are the non/pharmacologic treatments for body dysmorphic?
Non- therapy
Pharm- SSRIs
Clomipramine- TCA
91
Define Hoarding Disorder
Difficulty discarding possessions
Perceived need to save item
Distress w/ discarding
Accumulation of possessions that congests/clutters living areas
92
What is the essential feature of hoarding disorder?
Long standing difficulty discarding items regardless of value that is not a transient issue
93
How is Hoarding Disorder treated?
Difficult, CBT and SSRI
94
Define Trichotillomania
Hair pulling disorder most commonly in scalp, eye brow and eye lid area
95
What are the non-pharmaceutical ways for treating Trichotillomania
Biofeedback
Desensitization
Habit reversal
96
What are the pharmaceutical ways for treating Trichotillomania
```
In conjunction w/ Derm:
Topical steroids
Hydroxyzine
Antidepressants
Antipsychotics
```
97
Define Excoriation
Skin picking disorder usually in face, arms and hands
98
How is Excoriation treated?
CBT and habit reversal
Fluoxetine
Naltrexone
99
Define Somatic Sx
Sx associated w/ somatic nervous system
| Pain, tremor, fatigue, paralysis, SoB
100
Define Somatization
Physical Sx that mimics a dz that isn't there
| Psychological distress felt in physical form
101
What is the criteria for Somatic Symptom Disorder
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
How is Somatic Symptom Disorder categorized into Mild, Moderate or Severe?
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
What is the treatment plan for Somatic Symptom Disorder?
Non-Pharm: Social/Peer support
Pharm: Refractory cases respond to SSRI/SNRI
Don't use medications to replace appointments
104
Define Illness Anxiety Disorder
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
How is Illness Anxiety Disorder treated?
Same as Somatic Sx Disorder- therapy, education and support
106
Define Conversion Disorder
One Sx of altered voluntary motor/sensory function
| Objective evidence of incompatibility between Sx and neuro disoder
107
What are the 3 criteria for Conversion Disorder symptoms?
Motor- weak/paralysis, tremors, abnormal posturing, speech changes
Sensory- abnormal sensation, vision/hearing changes, globus sensation
Could mimic seizure, syncope or coma
108
How is Conversion Disorder treated?
Non-Pharm- hypnosis
| Pharm- none really help
109
Define Factitious Disorder
Falsified S/Sx or induced injury/dz with identified deception presenting them self as affected
Deception evident w/out sings of secondary gain
110
How is Factitious Disorder treated?
Early Psych- conjoint confrontation, biofeedback, self-hypnosis
111
Define Specific Phobia
Fear/anxiety OOPT about specific object/thing that provokes immediate fear/anxiety and occuring for +6mon
112
How are specific phobias treated?
```
Behavioral: desensitization
BCT- combo of this and Rx is better than monotherapy
SSRI/SNRI
Gabapentin
Propranolol- performance anxiety
```
113
Define Social Anxiety Disorder
Fear OOPT about social situation where they're exposed to scrutiny and expressing anxiety Sx will be negatively evaluated
114
What odd characteristics can PTs w/ Social Anxiety Disorder show?
Inadequately assertive, submissive or highly controlling
115
How is Social Anxiety Disorder treated?
```
Desensitization
CBT in combo w/ meds
SSRI/SNRI
Gabapentin
Propranolol- performance anxiety
```
116
Define Panic Disorder
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
How is Panic Disorder treated?
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
Define Agoraphobia
```
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
How is Agoraphobia treated?
Peer support- groups are helpful
SSRI/SNRI
Gabapentin
120
Define Generalized Anxiety Disorder
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
How is Generalized Anxiety Disorder treated
```
Relaxation/Desensitization
CBT
Antidepressants- Fist line treatment, can be anxiogenic
Benzo- avoid if possible
Buspirone
Gabapentin
Propranolol
```
122
What is the anxiety screening tool?
GAD-7
| Screening tool, not Dx aid
123
What makes up the Psych Interview
```
CC
HoPI
Mental Status Exam
AMSIT
Further eval
```
124
What is the acronym for conducting a mental status exam
```
AMSIT
Appearance, behavior
Mood
Sensorium
Intelligence
Thoughts
```
125
How is a PTs attention assessed during an interview?
Serial 7s
| Spelling backward
126
How is a PTs intelligence/cognition or higher cognitive functions assessed during an interview?
Calculating ability
| Proverb interpretation
127
What is assessed when analyzing a PTs thoughts, perceptions, judgement, or insight during a psych interview?
```
Circumstantialities
Derailment
Flight of ideas
Neologisms
Incoherence
Blocking
Confabulation
Perseveration
Echolalia
Clanging
```
128
How is a PTs insight/judgement assessed during an interview?
Insight:
Parable interpretation
Interpret events of personal Hx
Judgement:
Constructional ability- clock/figure drawing
129
What labs/rads can be used in the psychiatric interview?
Labs- heavy metals, toxins, infection
EEG
UDS- urine drug screen
130
What psych tests can be performed?
```
IQ test
PHQ-2
PHQ-9
GAD-7
ESS
ADHD questionnaire
```
131
What are the EPS side effects of SSRIs?
Akathisia
Dystonias
Parkinsonian syndrome
132
Define Serotonin Syndrome
Triad of abnormalities:
Cognitive effects- CANA
Neuromuscular- MRHT
Autonomic dysfunction- HHDT
133
How is Serotonin Syndrome treated?
With drawl of agent and supportive care for anxiety/seizures w/ Benzos
134
What are the top 4 Sx of each part of the Serotonin Syndrome triads?
Cognitive- confusion, agitation, coma, anxiety
Neuromuscular- myoclonus, hyperflexia, rigidity, tremor
Autonomic- hyperthermia, diaphoresis, tachycardia, HTN
135
Which SSRI is safe for abrupt d/c due to it's long half life?
Fluoxetine
136
Which SSRI has an FDA warning on it for cardiac reasons and which med doesn't have that warning?
QT prolongations w/ Citalopram at doses higher than 40mg/day
Escitalopram- no warning
137
What are the two main SNRIs
Duloxetine
| Venlafaxine
138
What are the NDRIs
Bupropion- less sex dysfunction
139
What are the Serotonin Receptor Antagonists
Trazodone
Mirtazapine
Nefazodone
140
When are specific SSRIs avoided?
Paroxetine- over weight
Citalopram- QT prolongation
Fluoxetine/Sertraline- aggitation, insomnia, pregnancy
Paroxetine- elderly
141
When are Circumstantialities usually seen?
When is Derailment commonly seen?
Common in pt’s with obsessions
Common in schizophrenia/mania/psychosis
142
Flight of Ideas are common in
Confabulation is commonly seen in
Mania
amnesia
143
Incoherence is commonly seen in ?
Echolalia is commonly seen in ?
schizophrenia, 24hr cable news channels
repetition of words and phrases - Autism
144
All meds classified as antidepressants increase ?
Concentration of NorEpi, Dopamine and/or Serotonin
145
What are the 3 ways antidepressants increase neurotransmitters?
What pregnancy category do they fall in?
Inhibit re-uptake
Block degredation
Increase release
Most are Category C
146
Where is serotonin released from?
Where does serotonin re-uptake occur?
Raphe neurons that project into limbic structures
Into presynaptic neuron
147
What are the 6 common SSRIs?
```
FF SPEC
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Citalopram
Escitalopram
```
148
What are the adverse effects of taking SSRIs
```
GI- nausea, diarrhea, constipation
CNS: agitation, tremor, panic
Sexual Dysfuntion
Serotonin Syndrome
EPS- akathisia, dystonia, parkinsonian Sx
```
149
What SSRIs are most activating?
Who needs to avoid these and when are they taken?
Fluxetine Sertraline
Avoid PTs w/ sleep difficulty
Take in the morning
150
What SSRIs are most sedating?
| What is the side effect of this group?
Paroxetine- worst weight gain
| Fluvoxamine
151
All SSRIs have reports of EPS side effects, but which one has the most reports?
Paroxetine
152
What are the common side effects of SNRI?
```
SHINS
Somnolence
HA
Insomnia
Nausea
Sex dysfunction,
```
153
What are the cautions/warning of TCA use?
DC SAP
Life threatening
Delirium Coma Seizure Arrhythmia Psychosis
154
What type of PT should not be given TCAs?
```
Suicidal ideations
Cardiovascular issues
Close angle glaucoma
Urinary retention
Prostate hypertrophy
```
155
What are the adverse effects of TCAs?
Anticholinergic effect- dry mouth, urine retention, constipation, blurred vision and will worsen BPH
156
TCA dry mouth side effect is linked to ?
Weight gain due to tendency to drink caloric beverages
157
PTs with which cardiovascular issues can take TCAs with caution?
Ischemic heart disease
Arrhythmia
Conduction disturbance
158
What are the adverse effects of taking Bupropion
HIIND
HA, Insomnia, Irritability, N/V, Dec appetite
Less sex dysfunction than other anti-depressants
159
What PTs are contraindicated to use Bupropion?
Seizures
Hx of anorexia/bulemia
Use/withdrawing from Benzo or ETOH
160
Function and use of Trazodone
Serotonin Receptor Agonist
| Depression and Insomnia
161
Function and use of Mirtazapine
Depression w/ SSRI but has profound sedative effect
162
Function and use of Nefazodone
Anxious depression or when SSRIs cause too much sex dysfunction
Black Box warning- liver failure
163
What is taken into considereation when selecting an antidepressant
Previous response of PT/Family to antidepressants
Side effects
Interactions
Comorbid conditions
164
How long is an antidepressant taken before it can be considered a failure?
Full therapeutic dose for 2-8wks or up to 12wks
165
Response and remission while taking antidepressants means ?
50% reduction of Sx
166
Vortioxetine us is avoided with PTs with what primary concern?
Nausea
167
Avoid Mirtazapine in what PTs?
Obese
| Hyperlipidemia
168
What are the 3 phases of antidepressant therapy?
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
When is depression classified as treatment resistant?
Two or more agents from different classes have been tried
170
What medications can be used as augmentation therapy in antidepressants?
Lithium- treatment resistant depression
Buspirone
Atypical antipsychotics
Electroconvulsive therapy
171
Which antidepressants are linked with pregnancy risks?
Fluoxetine- low birth weight
| Paroxetine- heart defects
172
What are the two generations of antipsychotics available for treatment?
First Gen- typical
| Second gen- atypical
173
Pharmacotherapy selection of antipsychotic depends on ? criteria?
```
PTs previous experience with antipsychotic
Adverse events
Concomitant conditions
Medicine interactions
PTs preferences
```
174
What are the typical antipsychotics?
What are the atypicals?
Cant Have Lucid Memories Try da xene
CRAPOLA IZ
175
What does the APA recommend when it comes to prescirbing antipsychotics?
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
What are the adverse reactions of antipsychotics?
Dystonia
Tardive Dyskinesia
Akathesia- most common EPS
Sex dysfunction
177
What is the black box warning of antipsychotics?
Inc mortality in elderly PTs w/ dimentia
178
Which antipsychotics are low potency typicals?
Chlorpromazine IV or PO
| Thioridazine PO
179
Which antipsychotics are high potency typicals?
Trifluoperazine PO
Fluphenzaine IM
Haloperidol IV IM PO
180
Why were atypical/2nd generation antipsychotics developed?
Reduce EPS, tardive dyskinesia and improved efficacy for positive Sx (except Clozapine)
181
Which second generation antipsychotics are PO, IV or IM?
PO- all
IV- Aripi, Olanz
IM- Risper, Paliperi, Zipra
182
Most antipsychotics are pregnancy category ?
What is the catch though?
C
| But, risk of EPS signs and withdrawl in neonates whose mother used antipsychs during 3rd trimester
183
What kind of binding do Benzos exervise?
Allosteric
184
Benzos are differentiated by properties, ones that have long half lives have what characteristics?
Effects last all day
Less pronounced with drawl Sx
More hangover Sx
185
Benzos are differentiated by properties, ones that have short half lives have what characteristics?
Quicker control of Sx
Acute management
Quick tolerance development
Breakthrough Sx- withdraw is common
186
Which Benzos are short acting?
TOM
Midazolam
Oxasepam
Triazolam
187
Which Benzos are intermediate acting?
```
LATE
Lorazepam
Alpazolam
Temazepam
Estazolam
```
188
Which Benzos are long acting?
```
CCD FQ
Chlordiazepoxide
Clonazepam
Diazepam
Flurazepam
Quazepam
```
189
What are the adverse effects of using Benzos?
Daytime Hangover- especially in long half life Benzos
Rebound insomnia- if d/c abrupt
Anterograde amnesia- preferred for surgery
190
Benzo treatment periods should be restricted to what time frame?
3-4mon as a bridge initiation of chronic therapy
| If long term use, tapered for months or even over a year
191
What are the with drawl Sx of Benzos?
```
Seizure
Psychosis
Disturbed sleep
Tremor
Nauseau
Muscle ache
Anxiety
Depression/confusion
```
192
What is the rule for using Benzos?
Use lowest effective dose of a longer half life for the shorted period possible
193
What is the rescue agent of Benzos?
Flumazenil IV- short acting so may need multiple doses to reverse long acting Benzos
194
PTs with ? Hx should not be given Flumazenil
Seizures
195
What meds can be used for Bipolar Dz?
Lithium
Anticonvulsants- Divalproex, Carbamazepine, Lamotrigine, Topiramate
Antipsychotics- all atypicals for acute mania except Clozapine and Iloperiodone
Benzos- Lorazepam, Diazepam
196
When is Lithium for Bipolar used?
Stabilize moods during manic phase
| Doesn't work on rapid cycles- 4 or more/year
197
What drugs are used as adjuncts with Lithium to cover agitation or other Sx?
Antipsychotics
| Benzos
198
When are antipsychotics d/c in Bipolar PTs?
When manic phase is resolved
199
What labs are performed in a pre-lithium work up?
```
CBC
E=
Renal function
Thryoid function
UA
ECG
Pregnancy
```
200
Lithium has a narrow index and requires serum blood monitoring between what ranges?
0.8-1.2mEq/L
201
What conditions can cause Lithium levels in the body to rise?
```
Dehydration
Fever
Vomit
Crash diet
Na restricted diets
```
202
When is Lithium adverse effects most common?
During initiation or after dose changes
203
What are the S/sx of Lithium toxicity?
```
Lethargy
Tremor
Confusion
Neuro/Psych
Seizure
Coma
Cardiac dysrhythmias
Dec thyroid function
```
204
What is the thyroid risk in long term Lithium use?
Hypothyroid and TSH induced toxic goiters
205
What drugs interact w/ Lithium
NSAIDs
Thiazides
ACEIs
K Sparing
206
If Lithium toxicity occurs, what steps are taken to help the PT?
D/c Lithium
Empty stomach contents
If level was >3mEq/L= dialysis
207
What anticonvulsants can be used in Bipolar?
Why do these need to be used cautiously?
Valproic Acid derivatives
Carbamazepine
Lamotrigine
Topiramate
Linked to depression
208
When are Valproic Acid compounds, Carbamazepine and Lamotrigine more effective than Lithium?
Rapid Cycling
Comorbid substance abuse
Secondary bipolar d/o
Mixed mania
209
Why are Valproic Acid derivatives used in Bipolar?
Acute/prophylactic management
210
When is Carbamazepine used in Bipolar?
Acute mania
Maintenance therapy
Added to Lithium for PTs who have responded to monotherapy
211
When is Lamotrigine used for Bipolar?
Maintenance therapy
212
Children with a specific phobia may demonstrate ? behavior?
Crying
Tantrums
Freezing
Clinging
213
How is the severity of a panic attack measured?
What is the criteria for moderate and less frequent categories?
Full Sx- 4+
Limited Sx >4
Moderate: 1/wk x months
Less: two/mon x years
214
What are the two types of Illness Anxiety Disorder?
Care Seeking- multiples appts with multiple tests
| Care avoidant- avoids hospitals and appointments
215
What are the differences between Illness Anxiety and Somatic Sx Disorder?
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
Define Cyclothymic
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
Define Schizoaffective Disorder
Uninterrupted period of illness
| Schizophrenia criteria is met, but there is a major mood episode- pervasive depressed mood
218
Define Schizophreniform Disorder
Identical to schizophrenia but duration is different- at least 1 mon but less than 6mon
(episode lasts for 1-6mon)
219
Define Schizotypal disorder
Acute discomfort and reduced capacity for close relationships
220
Define Rapid Eye Movement Sleep Behavior Disorder
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
Define Non-Rapid Eye Movement Sleep Arousal Disorder
Eyes are OPEN with various levels of awareness and motor activity
222
Define Sleep Related Hypoventilation
Medical/neuro disorder, medication use or substance use disorder
Morning HA, fatigue, sleepiness
223
Define Central Sleep Apnea
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
When is Bupropion used?
When is Buspropion used?
```
SOFPS
Smoker
Obese
Fatigue
Psychomotor slowing
Sex Dysfunction
```
BusPro- augment antidepressant therapy
225
One of the adverse effects of antipsychotics is Dystonia, which means?
Define Tardive Dyskinesia
Define Akathesia
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
What are the 4 times to use Propranolol?
Specific Phobias
Social Anxiety
Panic attacks
GAD
227
Three drugs better for use than Lithium?
CVL
| ConVuLse
