Psych forever Flashcards
when does bereavement become MDD
major depressive disorder in these circumstances requires the presence of marked functional impairment, morbid preoccupations with unrealistic guilt or worthlessness, SI, marked psychomotor retardation, and psychotic symptoms
How long does healthy bereavement last
2 months
1st line rx for mania
valporate- better tolerated vs Li
_______________- are generally believed to be the treatments of choice for persistent depressive disorder
Venlafaxine and bupropion
Onset 6 months post stroke. This disorder may occur in about 33% of stroke victims.
Post stroke depression
____________ is not seen in postpartum blues, but is
common in postpartum depressions.
Anhedonia
s/s must be present for _____ time to ddx cyclothymia
2 years
The most common complaints after ECT include
HA, nausea, and muscle soreness.
Memory impairment (both retrograde and anterograde) does occur but less frequently
Positron emission tomography (PET) scan has
consistently demonstrated _______________ in depressed patient
a decrease in blood flow and metabolism in the frontal lobe
In major depressive disorder, the REM sleep latency (the period of time between falling asleep and the
first period of REM sleep) is ___________
shortened
characterized by loss of pleasure in all activities (anhedonia), lack of reactivity (nothing can make the
patient feel better), intense guilt, significant weight loss, early morning awakening, and marked psychomotor retardation
Major depressive disorder with melancholic features
TCAs work well here
__________ is diagnosed when a major depressive episode develops in a patient with dysthymic disorder
Double depression
Approximately 40% of patients with a major depressive disorder also meet the criteria for persistent depressive disorder (dysthymia).
________ are considered to be more effective than other classes of antidepressants in atypical depression
MAOIs
four Ds of malpractice:
(1) a duty existed toward the patient on the part of the psychiatrist
(2) a deviation from the standard of practice occurred (3) this deviation bore a direct causal relationship to the untoward outcome
4) damages occurred as a result
five elements that make up what is
considered a reasonable standard of care for disclosing information needed to obtain informed
consent are
diagnosis treatment consequences prognosis alternatives to the proposed treatment (including risks and benefits)
The Tarasoff decision was a landmark case in determining that psychotherapists have an obligation to
warn third parties who are in danger
__________ is the most common reason for malpractice claims in psychiatry, accounting for 33% of all claims.
Improper treatment
This is followed by attempted/ completed SI, which at 20%
The principle of _____________ refers to preventing or removing harm and promoting well-being.
beneficence
Tarasoff II stated that once a therapist has reasonably determined that a patient poses a serious danger of violence to others, the therapist must
“bears a duty to exercise reasonable care to protect the foreseeable victim of that danger.”
Tarasoff II
Anti- depressents for the elderly
The SSRIs: fluoxetine paroxetine, sertraline fluvoxamine citalopram
unique agents such as bupropion, venlafaxine, nefazodone, and mirtazapine.
Name the SSRIs
fluoxetine paroxetine, sertraline fluvoxamine citalopram
citalopram is
SSRI
fluvoxamine is
SSRI
The tricyclic drugs include
imipramine
desipramine
amitriptyline
nortriptyline.
TCAs treat?
They are effective in the treatment of depression;
panic disorder, generalized anxiety disorder, and separation anxiety; enuresis; and ADHD
Phenelzine and tranylcypromine are both ______,
MAO inhibitors
major s/e: hypotension
tranylcypromine is?
MAOi
Clozapine w/ WBC = 2000 to 3000 should cause psychiatrists to
get daily CBCs and stop the clozapine. It may be reinstituted after the WBCs normalize.
Clozapine w/ wbc 3000-3500 with or without clinical symptoms should cause the psychiatrist to
monitor the patient closely and institute a minimum of twice-weekly CBC tests with differentials included.
With an uncomplicated agranulocytosis (no signs of infection) on clozapine, the patient should be
placed in protective isolation
d/c clozapine
bone marrow specimen to see if progenitor cells are being suppressed.
Clozapine must not be restarted
In Li overdose, __________ makes dialysis necessary
Li levels >2.5 nEq/L
Ramelteon use and s/e
Ramelteon reduces time to sleep onset
s/es headache.
do not use in severe hepatic impairment, severe sleep apnea, or severe COPD
Carbamazepine warnings
can cause aplastic anemia, agranulocytosis, thrombocytopenia, and leukopenia.
risk of hepatotoxicity.
benign rash–> drug should be discontinued if this occurs because progression to a severe rash is unpredictable
________ antidepressant is associated with a great tendency to gain weight
Amitriptyline
All women of child-bearing potential who must take valproic acid should be given _____ supplementation.
folic acid
neuroepileptic dystonia rx in ER
benztropine or diphenhydramine IM in an emergency room setting
RX for neuroleptic akathesia
beta-adrenergic receptor antagonists ie propranolol, though benzodiazepines and anticholinergics may also be somewhat effective
ECT anesthesia
Methohexital is commonly used for ECT
lower cardiac risks than other barbiturates
The only medication approved for shift work
sleep disorder is ________
modafinil
disulfiram moa
Acetaldehyde dehydrogenase inhibition
_______ is the preferred treatment
for psychotic symptoms in patients with Parkinson disease because?
Quetiapine due to its sedative quality and relative lack of extrapyramidal effects.
____________ is considered the safest and the best-tolerated anticonvulsant for patients taking clozapine who experience seizures
Valproate
