psych clin Flashcards
trx of SAD
light therapy and bupropion
which drugs are specific for premenstrual dysphoric disorder
sertraline
perioxitine
fluoxetine
trx for bipolar (and their AEs)
lithium, valproic acid, carbamezapine (check blood levels)
second gen antipsychotics to calm mania
lamotrigine for bipolar w depression
can cause STEVEN-JOHNSON SYNDROME= rare but deadly allergic rash from neck up
criterion for social anxiety disorder/social phobia
persistent fear of social performance/exposure to unfamiliar ppl
may have panic attacks
person recognizes their fear is unreasonable/excessive
social anxiety disorder has increased risk of what
alc dependence, severe depression
most often medical ds causes psych sx
UTI pnuemonia electrolyte abn sepsis thyroid hypoxia hypoglycemia hyponatremia (elderly w ssris) stroke, CNS lesion MI
trx for delerium in ER
sedative: haloperidol +lorazepam (IM 15-30 min)
only haloperidol in elderly
keep pt safe, in quiet room
describe labs for alc withdrawal
low platelets on CBC MCV>100 hypoNa on BMP dec hepatic function blood alc level drug urine screen
trx for alc withdrawal in the ER
IV fluids
thiamine
glucose
meds= IV lorazepam (if liver impaired)
IV diazepam/chlordiazepoxide (if liver good)
meds to give violent pts in the ER
haloperidol, lorazepam, olanzapine, ketamine
get full labs and consults
trx for PTSD
SSRi therapy prazosen for nightmares EMDR (REM to desensitize) NO GIVE BENZOS bc of increased risk of addiction
acute stress disorder vs PTSD
ASD= 3 days 1 month
criterion for adjustment disorder
emotional/behavior changes associated witha stressor within 3 months but no longer than 6 months
=not proportionate disress and decreased functioning
sx associated with conversion disorder=
unexplained neural deficits w change in voluntary movement, initiated or worsened by a stressor
~pseudo-seizures (normal EEG), numbness, paralysis, tremor
NOT fake
associated with sexual and physical abuse as a child
what is factitious disoder
red flad?
munchausen
munchausen by proxy
red flag= lots of allergies
risk factors for alzheimers
(progressive and irreversible)
female, FH, head trauma, down’s syndrome
=50-60% of dementia
risk factors for vascular dementia
male, old, HTN, CV ds
what is pick’s ds
a type of progressive dementia
associated with frontotemporal lobe atrophy
=young, volatile, and violent
describe lewy body dementia
memory loss, parkinsonian sx, frank visual hallucinations
what are some reversible causes of dementia
drugs hypothyroid metabolic ds hematomas normal P hydrocephalus inc ICP
what labs are important when you suspect dementia
thyroid, glucose, vitamines
b12 (<400 means need trx)
kidney function, A1c
what imaging test can diagnose Alzheimer
pet scan
causes of delirium w psychosis in elderly
drugs infection retention/constipation hypoxemia stroke/seizure lack of sleep
what can happen if you give elderly diphenhydramine
seretonin syndrome and psychosis
explain the domains of adaptive functioning in intellectual disability
conceptual= school for that age (preschool=language, school=reading and regulate emotions, adults= stuck at school level)
social domain= v gullible and easily manipulated by peers
practical domain= personal care and daily living tasks
what is the difference between intellectual disability and global developmental delay
GDD is just the dx for people who can’t be tested, i.e. kids too young, post severe head injury
define language disorder
persistent difficulty of acquisition and use of language across modality
= x comprehesion (less vocab, sentence structure, impaired discourse)
define speech sound disorder
diff PRODUCTION of speech
define childhood onset fluency disorder
stuttering (time patterning)
define social (pragmatic) communication disorder
diff w social use of verbal and nonverbal communication
inappropriate greeting and info sharing, can’t understand the rules of language, diff w sarcasm
=”autism of language”, associated w the delay of reaching milestones
what must be present for dx of autism spectrum
all 3 deficits
- in social-emotional reciprocity
- nonverbal communication
- in making, maintaining, and understanding relationships
+ 2+ of below
- repetitive motor movements, use of objects, speech
- insistence of sameness, inflexibility
- highly restricted, fixated interests
- hyper/hypo sensitivity to sensory input
trx for autism spectrum
most consistently useful= education and support for pt, parents, family, teachers
parallel process
FDA approved meds= risperidone, aripriprazole (for agitation)
off label= valproic acid, gabapentin, stimulants, alpha agonists, anti-depressants
what specifiers are needed dx of autism spectrum disorder
w or w/o accompanying intellectual repair
w or w/o accompanying language repair
associated w neurodev/mental/behav disorder
associated w catatonia
associated a med/gen/env factor
with the tourrette’s triad, which sx are more associated w males and females
males= tics, ADHD females= OCD sx
ADHD is associated with what parts of the brain
prefrontal cortex and dorsal anterior midcingulate cortex
DA and NE
which tests can be used to dx for ADHD
TOVA (variables for attention)
Conner’s continuous performance tasks
med trx for ADHD
alpha 2 adrenergic agonists= guanfacine and clonidine
bupropion (antidepress w mixed catechol effect)
atomexatine (not first line bc CV AR)
modafanil= adults only= inhibit DA uptake= can cause DRESS syndrome, steven-johnson syndrome, epidermal
necrolysis
methylphenidate= increase extracell DA
define developmental coordination disorder
-acquire and execute coordinated motor skills way behind expected age
v clumsy
define stereotypic movement disorder
specificities?
repetitive, pointless motor behavior
specific= w self-injurious behavior, w known med/gen/neurodev/env factor
severity= mild= easily suppressed mod= require explicit protective measure severe= continuous monitoring
meds for tourrettes
ONLY FDA: haloperidol, pimozide, aripriprazol (antiDA)
fluphenazine, risperidone
guanfacine, clonidine
VMAT2 inhibitor (-benazine)
botulin-toxin injections
anticonvulsants= topiramate, gabapentin, valproic acid
what is the reward deficiency syndrome
DA malfunction–> vulnerability to addiction
associated w hippocampus and amygdala
what blood alcohol level does intoxication start at
0.08 g/dL
med trx for alcohol withdrawal
benzos (makre sure no alc in blood–> resp suppression)
anticonvulsants= carbomezapine, gabapentin, valproic acid
disulfiram (=more harm than good)
naltrexon
acamprosate (3x a day)
to taper off benzos, which long eliminating drugs can you switch them to
clonazepam, chlordiazepoxide, diazepam
what drugs can you give if you need to taper off benzos or barbs quickly
best= gabapentin, tizanidine
also carbamezapine and valproic acid
which benzos are not effected by age or hepatic insufficiency (bc only glucoronidation)
oxazepam, lorazepam, temazepam
can use w cirrhosis
trx for opioid withdrawal
antiemetics, antacids, anti-diarrhea, M relaxant, NSAIDs, clonidine,
methadone–> high risk qtc prolongation
naltrexone
buprenorphine= highly motivated patients
cocaine use can have what medical effects
risk of MI, CVA (get EKG)
rhabdomyolysis–> compartment syndrome
psychosis bc of xneuroadaptation
SEs of chronic amphetamine use
neurotoxicity from glutamate, axonal degeneration, permanent psychosis
how does tobacco change drug metabolism
neuroadaptation?
induce cyp1a2 (i.e. olanzapine)
DA release from ventral tegmental area to nucleus accumbens
med trx for tobacco use
bupropion
varenicline
trx of PCP intoxication
antipsychotics and benzos, less stimulating environment
terms for classical conditioning
(simultaneous)
condition, unconditioned response and stimulus
extinction
terms for operant conditioning
(in order)
positive/negative reinforcement/punishment
phases of sexual response cycle
- desire= drive (bio) + motivation (willing)+ wish fullfilment (cultural hope)
- excitement= arousal phase (erection, vaginal lubrication, nipples hard) vasodilation of genitals and M in body contractions
- orgasm = rhythmic contractions of perineal Ms
- resolution (rapid if orgasmed, hours if didnt’)
Ms have refractory period and fast resolution
Fs have no refractory period, long resultion
define female sexual interest/arousal disorder
decreased sexual interest for 6+ months for 3+..
less interset, thoughts, receptiveness, pleausre, sensations
define male hypoactive sexual desire
persistent deficient sexual fantasies/desire for 6+ months
define erectile disorder
at least 6+ months of
cant get erection, keep it, or is less rigid
define female orgasmic disorder
delay/no orgasm for 6+ months
define delayed ejaculation disorder
6+ months almost always can’t ejaculate
define premature ejaculation disorder
6+ months of ejaculation within 1 min of penetration
define genito-pelvic pain penetration disorder
6+ months of 1+
pain w penetration, tensing/tightened of floor Ms w penetration, fear of pain
define voyeurism
peeping tom, 18+ yo
define fetishistic disorder
arousal from nonliving objects, not focused on genital parts
define pedophilia
attracted to kids <13,
must be 16+ and 5+ years older than kid
can be exclusive or nonexclusive
define frotteuristic disorder
touching/rubbing against nonconsenting individuals
male 15-25
risk factors of child abuse
child what makes taking care more diff colicky infant <1 year nonbio parent
parent criminla hx substance abuse hx of mental health teen parents
social
isolation, poverty
most common type of child abuse, most commonly causes death
neglect
response to suspected emotional abuse
if isolated w no immediate harm: refer to family therapy and parenting classes
if recurrent w immediate harm: call CPS
response to neglectful child abuse
call CPS, send social worker to home
response to physical or sexual child abuse
call CPS
increased risk of sexual abuse in what population of children
deaf children
trans kids
intellectually disabled
risk factors for elder abuse
elders- dementia, psych dx, physical dependence, incontinence
perpetrator- substance abuse, male, financial dependence on victim
pharm trx for anorexia
not first line, only use if resistant
NO USE BUPROPION or TCA
only give SSRIs if anxiety/depression is bad enough to interfere w care
olanzopine= for help w weight gain lorazepam= decrease anxiety associated w eating
trx for bulimia
gold standard = CBT
give CBT+pharm+nutritional rehab
meds= 1st line= fluoxetine
2nd line= sertralin/fluvoxamine
3rd= TCA
trx for binge eating disorder
1st line= CBT+interpersonal therapy
describe stress theory
sympathetic response to stress
= increase catechol release, serotonin turnover, DA transmision
=increase CRH–>ACTH
decrease growth, immunity
