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Exam 2 > Psychiatric > Flashcards

Psychiatric Flashcards

1
Q

Patient with suicidal ideation:

A

Assess if patient has a plan

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2
Q

Anti-anxiety medication without withdrawal side effects

A

Buspar

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3
Q

Risk factors for benzodiazepine use in the elderly

A

Falls and confusion

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4
Q

When is Zoloft first line therapy as an anti-depressant?

A

Pregnancy

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5
Q

First line therapy for an elderly patient who is depressed, not sleeping and not eating

A

Remeron

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6
Q

Anti-psychotic medication that can cause side effects of elevated glucose/worsening DM:

A

Olanzapine, risperidone, clozapine

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7
Q

Anti-depressants that can cause weight gain:

A

Paxil / Remeron

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8
Q

Anti-depressants that can’t be uses with seizures:

A

Wellbutrin

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9
Q

Erectile dysfunction/decreased libido due to SSRI:

A

Add Wellbutrin

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10
Q

Cymbalta as first line treatment:

A

Nerve pain

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11
Q

How many weeks for meds to be therapeutic?

A

4 to 6 weeks

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12
Q

Serotonin Syndrome:

A
  • Occurs when you take medications that cause high levels of the chemical serotonin to accumulate in your body.
  • SSRI increases serotonin levels
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13
Q

Patients experiencing side effects from SSRI:

A
  • Never stop taking medication abruptly

- Educate that side effects are transient, most will go away

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14
Q

Most stimulating anti-depressant:

A
  • Wellbutrin –> never give at night, take in the morning!

- Take Lexapro in the morning as well

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15
Q

Be cautious about giving stimulating anti-depressants to depressed patients:

A
  • May kill themselves. Be careful with meds that will keep them awake.
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16
Q

Patients with sx of depression and weight gain, check what labs?

A
  • Check for hypothyroidism
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17
Q

Patient who are anxious, restless, eyes are bugged out, check what labs?

A
  • Check for hyperthyroidism

- Toxicology

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18
Q

Labs to check before starting SSRI:

A
  • Sodium level
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19
Q

Autism spectrum disorder symptoms:

A
  • Lack of eye contact
  • Don’t know how to play with toys
  • Anger/frustration
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20
Q

Autism spectrum disorder treatment/ADHD

A
  • First line tx: Ritalin/Methylphenidate/Concerta (stimulants)
    o Dose: 5mg once per day on Day 1, then 5mg 2 times per day. Titrate.
    o MDD: ≤25 kg = 35 mg. 25 kg = 60 mg.
  • Side effects of Ritalin = decreased appetite, weight loss, anxious, nervousness, irritability, and tachycardia
  • Non-stimulant tx: Guanfacine/Intuniv
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21
Q

Vulnerable groups at high risks for suicide:

A
  • Elderly patients with multiple comorbidities, decreased/lack of support systems
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22
Q

Binge-eating disorder treatment

A

Vyvanse

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23
Q

GAD-7 questionnaire:

A

How often have they been bothered by the following over the past 2 weeks?

  • Feeling nervous, anxious, or on edge
  • Not being able to stop or control worrying
  • Worrying too much about different things
  • Trouble relaxing
  • Being so restless that it’s hard to sit still
  • Becoming easily annoyed or irritable
  • Feeling afraid as if something awful might happen

5-9 = Mild Monitor
10-14= Moderate Possible clinically significant condition
>15=Severe Active treatment probably warranted

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24
Q

PHQ-9 questionnaire:

A

How often have they been bothered by the following over the past 2 weeks?

  • Little interest or pleasure in doing things?
  • Feeling down, depressed, or hopeless?
  • Trouble falling or staying asleep, or sleeping too much?
  • Feeling tired or having little energy?
  • Poor appetite or overeating?
  • Feeling bad about yourself — or that you are a failure or have let yourself or your family down?
  • Trouble concentrating on things, such as reading the newspaper or watching television?
  • Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual?
  • Thoughts that you would be better off dead, or thoughts of hurting yourself in some way?
Scoring:
0-4	        Minimal or none	
5-9.   	Mild
10-14	Moderate
15-19	Moderately severe	
20-27	Severe

*15-27: Warrants active treatment with psychotherapy, medications, or combination

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25
Q

First line tx for anxiety and depression

A

Lexapro

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26
Q

Patient with no hx seizures c/o difficulty getting out of bed, depressed, not acutely suicidal, but not able to function

A

First line tx = Wellbutrin in the morning

27
Q

Anxious distress sx:

A
  • Restlessness
  • Tension
  • Impaired concentration
  • Fear that something awful will happen
  • Feeling that the individual might lose control of him or herself
28
Q

Substance and medication induced depressive disorder:

A
  • Mood disturbance develops during or soon after using substances for recreational purposes or using prescribed medications; the substances/medications are judged to be capable of causing the mood disturbance. In addition, the disturbance causes significant distress or impairs psychosocial functioning.
  • Depressive syndromes may be caused by intoxication or withdrawal from a wide range of substances that are encountered in substance-related and addictive disorders, including alcohol, amphetamines, cannabis, cocaine, and stimulants.
29
Q

Risk factors for post-natal depression:

A
  • Past hx of perinatal or non-perinatal depression
  • Advanced age
  • Single marital status
30
Q

Patient taking same SSRI for long time (>10 years) and is well controlled but is now pregnant. Medication is a category C:

A
  • Continue same medication. Greater risks trying to switch medications –> increased psychotic features, suicidal ideation, and functional incapacitation
31
Q

DSM-5 criteria for GAD

A
  • A) Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least six months, about a number of events or activities (such as work or school performance).
  • B) The individual finds it difficult to control the worry.
  • C) The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past six months):
    o 1. Restlessness or feeling keyed up or on edge
    o 2. Being easily fatigued
    o 3. Difficulty concentrating or mind going blank
    o 4. Irritability
    o 5. Muscle tension
    o 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep)
  • D) The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • E) The disturbance is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication) or another medical condition (eg, hyperthyroidism).
  • F) The disturbance is not better explained by another mental disorder (eg, anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder). Because the majority of the anxiety symptoms are not specific to GAD, it is important to exclude the other anxiety disorders before making the diagnosis.
32
Q

OCD vs GAD:

A
  • OCD = Primal fear: contamination or harm. Ritualistic.

- GAD = Broad anxiety: exam, work, finances, health, family, etc. Everyday events and problems

33
Q

Celexa/Citalopram side effects:

A
  • Can prolong QT interval with increasing blood levels
  • Advantages:
    o Lower risk of insomnia/agitation
    o Few drug interactions
34
Q

Zoloft/Sertraline side effects:

A
  • Greater risk of insomnia/agitation

- More frequent diarrhea and other gastrointestinal complaints

35
Q

Fluoxetine/Prozac side effects:

A
  • Greater risk of insomnia/agitation
  • No withdrawal symptoms if not tapered
  • Takes weeks to reach steady blood levels due to long half-life
  • Can cause decreased libido –> add Wellbutrin
36
Q

Fluvoxamine/Luvox side effects:

A
  • Lower risk of insomnia/agitation
  • Withdrawal symptoms if not tapered
  • Significant drug interactions
37
Q

Wellbutrin MDD

A

300mg

38
Q

Lexapro MDD

A

20mg

39
Q

Sertraline MDD

A

200mg

40
Q

Venlafaxine MDD

A

300mg

41
Q

If patient has reached MDD but is still anxious, what can you add?

A

Buspar

42
Q

Most common childhood onset psychiatric disorder:

A
  • Anxiety: associated with educational underachievement and co-occurring psychiatric conditions; functional impairment that extends into adulthood
  • Risk factors:
    o Social/environmental factors
    o Genetics/biological factors
    o Psychological factors
43
Q

Teenager with anorexia screening:

A

Gold standard dx interview: Anxiety Disorders Interview Schedule (ADIS)

44
Q

Monitoring schedule for antidepressant in children:

A
  • Follow-up weekly x 4 weeks, then biweekly for second month, and monthly x 12 months minimum
45
Q

First line tx for mild to moderate anxiety disorder for 12-year-old

A

CBT

46
Q

Modified Checklist for Autism in Toddlers (M-CHAT):

A

Assess risk for ASD in children between 16 and 30 months of age
The total score for the first stage determines the risk category and follow-up:
o 0 to 2 – Low risk; no further evaluation unless there are other risk factors
o 3 to 7 – Medium risk; requires administration of the second stage; a total score of ≥2 on the second stage warrants immediate referral for diagnostic evaluation and early intervention
o 8 to 20 – High risk; warrants immediate referral for diagnostic evaluation and early intervention; no need for follow-up interview

47
Q

Parent’s Observations of Social Interactions (POSI):

A
  • ASD screening in children 16 months to 35 months
  • Scoring: A result of three or more points in the last three columns indicates that a child is “at risk” and needs further evaluation or investigation.
48
Q

Screening Tool for Autism in Toddlers and Young Children (STAT):

A
  • ASD screening in children age 24 to 36 months
  • Consists of a 20-minute-long play-based session during which 12 activities in four domains are observed: play, requesting, directing attention, and motor imitation. Each domain is scored as the proportion of failed items to total items, with an overall score ranging from 0 to 4, and higher scores indicating greater impairment.
49
Q

Vanderbilt ADHD Rating Scale (VADPRS):

A

Assessment tool for attention deficit hyperactivity disorder symptoms and their effects on behavior and academic performance in children ages 6–12 (school age).

50
Q

How to select tests for autism spectrum:

A

Age and if screened previously

51
Q

Hoarding most common comorbid mental disorder:

A

GAD (31-37%)

52
Q

Screening tools for hoarding:

A
  • Structured Interview for Hoarding Disorder
  • Hoarding Rating Scale
  • Clutter Image Rating scale
53
Q

Gambling risk factors/screening/dx

A
  • Meet 4+ DSMV criteria for diagnosis
  • Risk factors: Age, gender, adults with mental health treatment, African American, family hx of gambling, lower socioeconomic status, seat belt non-use
  • Screening tool for pathological gambling: South Oaks Gambling Screen (SOGS)
54
Q

Low risk gambler:

A

Someone who has gambled but never lost more than $100 in a single day or year or lost more than $100 in a single day or year but reported none of the DSM-IV criteria

55
Q

At-risk gambler:

A

Someone who has lost more than $100 in a single day or year and reported one or two DSM-IV criteria.

56
Q

Problem gambler:

A

Someone who has lost more than $100 in a single day or year and reported three or four DSM-IV criteria.

57
Q

Acute intoxication/withdrawal sx:

A

Diaphoretic, slurred speech, unsteady gait, pinpoint pupils, tachycardia, red eyes, watery eyes, runny nose

58
Q

Alcoholism tx

A
  • Start the discussion –> are they ready to stop drinking?
  • Labs: LFTs
  • If patient is still currently drinking –> prescribe Naltrexone (also has long-term injectable form, Vivitrol)
  • Campral/ acamprosate is normally not started until about five days after a person stops drinking.
  • Follow up weekly after starting pharmacotherapy
59
Q

Screening adolescents at higher risk for alcohol and drug use:

A

CRAFFT

60
Q

Substance abuse disorder clinical manifestations:

A
  • Poor dentation
  • Poor hygiene
  • Malnourished
  • Cellulitis
  • Hepatomegaly
61
Q

Russell’s sign

A

calluses on the knuckles or back of the hand due to repeated self-induced vomiting over long periods of time (bulimia)

62
Q

Treatment for cannabis withdrawal / acetaminophen overdose:

A
  • N-Acetylcysteine (NAC/mucomyst)

- Other tx: CBT, motivational enhancement treatment (MET)

63
Q

Hoarding dx and tx

A

Needs to meet 6 DSM-5 criteria for diagnosis
- First line tx: CBT
- Techniques: ask open ended questions, reflective listening, paraphrasing
o DO NOT SET GOALS –> causes them too much stress

Exam 2 (3 decks)

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