Psych treatments: Childhood, mood, and psychosis Flashcards
What is the treatment for mental retardation
Genetic counseling for expectant mothers, special education, and behavior therapy to reduce negative behaviors
The four pervasive developmental disorders occur before age 3 and include autistic disorder, rett disorder, childhood disintegrative disorder, and asperger disorder. What is the treatment for autistic disorder and childhood disintegrative disorder
Make them achieve independant living, use behavior modification programs
If aggressive, antipsychotics
The four pervasive developmental disorders occur before age 3 and include autistic disorder, rett disorder, childhood disintegrative disorder, and asperger disorder. What is the treatment for rett disorder?
Symptomatic
- ) Behavior therapy for self injurious behavior
- ) Physiotherapy for muscular dysfunction
The four pervasive developmental disorders occur before age 3 and include autistic disorder, rett disorder, childhood disintegrative disorder, and asperger disorder. What is the treatment for asperger syndrome
None
What is the treatment and side effects for attention deficit hyperactivity disorder
First line: Methylphenidate and dextroamphetamine - side effects are insomnia, decreased appetite, and headache
Second line: Atomexetine (NE reuptake inhibitor) - even though second line, less side effects so choose this on USMLE
Two disruptive behavior disorders are oppositional defiant disorder (argue but don’t break law) and conduct disorder (breaks laws). What is the treatment for oppositional defiant disorder
ODD: Teach parents appropriate child management skills
Two disruptive behavior disorders are oppositional defiant disorder (argue but don’t break law) and conduct disorder (breaks laws). What is the treatment for conduct disorder
Behavior intervention - rewards for prosocial or nonaggressive behavior
If aggressive, use antipsychotics
What is the treatment for tourette disoder
Antipsychotics (dopamine antagonists), i.e. risperidone
What is the most common medical cause of major depression and must be ruled out
Hypothyroidism
What is the treatments for depression
SSRI’s and cognitive psychotherapy to develop positive ways of thinking
What is depression + neuropathic pain treated with
Desvenlafaxine
What is depression but people who are afraid of weight gain and sexual side effects given
Buproprion
For bipolar disorder, what other causes must be ruled out
Cocaine and amphetamines - get urine drug screen
If someone with bipolar disorder is in the acute manic stage, what medications should you use
Lithium
Can also use valproic acid, atypical antipsychotics
If someone with bipolar disorder is in the depression stage, what medications should you use
Lithium or lamotrigine
Atypical depression is composed of reverse vegetative symptoms, depression worse in evening, and feeling of heaviness. What is the treatment
SSRI’s or MAOi’s
Choose SSRI’s on USMLE if both given, but MAOi’s are usually the answer
What is the treatment for seasonal affective disorder
Phototherapy and buproprion
What is the treatment for postpartum blues, postpartum depression, and postpartum psychosis. Postpartum depression and above have negative feelings towards babies
Postpartum blues: Supportive
Postpartum depression: Antidepressants. Postpartum psychosis: Antipsychotics and lithium
Bereavement (grief) lasts less than 6 months. What is the treatment
Psychotherapy (never medical therapy)
What is the treatment for serotonin syndrome
Stop SSRI, symptomatic treatment, and cyproheptadine
What is the difference between brief psychotic disorder, schizophreniform, and schizophrenia
Duration of time
Brief psychotic is only hallucinations, delusions, disorganized speech, and disorganized behavior
Schizophreniform has added negative symptoms
Schizophrenia is really bad functioning - affects men earlier but affects both groups equally
Like mania, what must be ruled out with brief psychotic disorder, schizophreniform, and schizophrenia
Cocaine and amphetamine abuse - always get urine drug screen
After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the paranoid type
Delusions and hallucinations of persecutory type
After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the catatonic type
Psychomotor disturbances - stupor, rigidity, excitement, posturing
After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the disorganized type
Disinhibited with little contact with reality. Early age of onset and worst prognosis
The five kinds of psychosis are paranoid, catatonic, disorganized, residual and undifferentiated. What is the residual type
Lack of positive symptoms
After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What is the undifferentiated type
Not meet criteria for other types
After distinguishing schizophrenia from the other forms, schizophrenia can be further divided into paranoid, catatonic, disorganized, residual and undifferentiated. What are all five types summed up
- ) Paranoid: Delusions and hallucinations of persecutory or grandiose type
- ) Catatonic: Psychomotor disturbances
- ) Disorganized: Disinhibited behavior, disheveled, and bizarre emotional responses
- ) Residual: Only negative symptoms
- ) Undifferentiated: Not meeting criteria for other types
Someone with psychosis presents as acutely psychotic. What is the treatment
Atypical antipsychotic and ensure patient safety
Someone with psychosis presents as acutely psychotic in an emergency situation. What is the treatment
IM injection of olanzapine or ziprasidone
Someone with psychosis is not compliant with their medications. What should you give them
Long acting antipsychotic
If patient does not respond to antipsychotic, what is the second line treatment
Clozapine
What are the side effects of olanzapine and who should you avoid it in
Weight gain and diabetes. Avoid in obese patients and diabetics
What is the side effects of risperidone
Highest chance of movement disorders. Medium risk of obesity and diabetes
If movement disorder does occur, best management strategy is replace with clozapine
What is the side effects of quetiapine
Lowest chance of movement disorders. Medium risk of obesity and diabetes
What is the side effects of ziprasidone
QT prolongation, avoid in patients with conduction defects. Lowest chance of weight gain and obesity
What is the side effect of clozapine
- ) Agranulocytosis - monitor CBC regular basis
- ) Lowers seizure threshold
- ) Lowest chance of movement disorder (EPS) of all
What is the treatment for delusional disorder
Atypical antipsychotics
What is neuromalignant syndrome and its treatment?
Side effect of dopamine antagonists (antipsychotics) that results in muscle rigidity (main hallmark) with hyperthermia, altered mental status, fever
Leads to elevated CPK levels, and potential complication is rhabdomyolysis leading to myoglobinuria
Treated with Dantrolene (muscle relaxant) and bromocriptine (dopamine agonist)
What is serotonin syndrome and its treatment?
Induced by having too much serotonin (i.e. combining SSRI and MAOi) causing clonus (rhythmic contractions) with hyperthermia, altered mental status, and dilated pupils
Treated by stopping SSRI and give cyproheptadine
What are the similarities and differences between serotonin syndrome and neuromalignant syndrome
Similarities: Both cause altered mental status with hypertonia and autonomic overdrive (hyperthermia, tachy, hypertension, etc)
Differences: Neuromalignant syndrome has a lot of rigidity in all muscle groups, while serotonin syndrome has clonus (rhythmic contractions) with mild hypertonicity. Serotonin syndrome has hyperreflexia and neuromalignant syndrome has hyporeflexia
