Psychiatric/Behavioral & Substance Abuse Flashcards
Treatment for acute dystonia
Anti-cholinergics
Diphenydramine
Benztropine
Trihexyphenidyl
Pathophysiology of Fragile X
Hypermethylation and impaired transcription of the protein FMRP
More than 200 repeats lead to total silencing of the gene and absence of the protein
Typical features of fragile X
Delayed milestones
Autistic behavior
Intellectual disability
Elongated face
Large testes
Initial medical workup for new-onset psychosis
Basic metabolic panel
CBC
Thyroid function tests
Urine toxicology
Syphilis screening
Factitious disorder
A patient intentionally produces illness with the goal of assuming the sick role.
Malingering
Patients feign symptoms to obtain external rewards
Borderline personality disorder
- Diagnostic criteria
- Treatment
Paranoid personality disorder
Pervasive pattern of suspiciousness and mistrust of others
Schizoid personality disorder
Lifelong pattern of detachment from social relationships and restricted range of emotions.
Do not experience delusions or dissociative symptoms.
Schizotypal personality disorder
Odd, holding magical beliefs
Strange, but not overtly psychotic though processes
Hypothyroidism (psychiatric symptoms)
Depression
May experience psychotic symptoms in severe cases
Signs of alcohol withdrawal
Sympathetic overactivity
Tachycardia, elevated blood pressure, restlessness, tremulousness
Dilated pupils
HIV medication with neuropsychiatric side effects
Efavirenz
Insomnia with vivid dreams
Depression
Anxiety
Signs of opioid intoxication
Decreased respiratory rate and tidal volume (respiratory acidosis)
Hypotension
Hypothermia
Myosis
Decreased bowel sounds
Fetal exposure to phenytoin
Neural tube defects
Cardiac anomalies
Dysmorphic facies: Cleft lip, narrow bifrontal diameter, midface hypoplasia, broad and depressed nasal bridge, long philtrum
Fetal exposure to phenytoin
Nail and digit hypoplasia
Dysmorphic facies
Mental retardation
Growth deficiency
Fetal alcohol syndrome
Growth deficiency
Long, smooth philtrum
Small palpebral fissures
Thin upper lip
CNS abnormalities, including mental retardation
Prenatal exposure to cocaine
Jitteriness
Excessive sucking
Hyperactive Moro reflex
Key features of somatic symptom and related disorders
- Somatic symptom disorder
- Illness anxiety disorder
- Conversion disorder (functional neurologic symptom disorder)
- Factitious disorder
- Malingering
Social anxiety disorder
- Diagnosis
- Treatment
Distinguishing between Bipolar I and Bipolar II
Antipsychotic extrapyramidal effects
- Extrapyramidal symptoms
- Treatment
Psychosocial intervention that decreases risk of relapse in patients with schizophrenia
Minimizing stress and conflict in the home
Narcolepsy
- DSM-5 diagnostic criteria
- Associated features
Panic disorder
- Clinical features
- Treatment
Assessment and managment of suicidality
- Assessment
- Managment
Differential diagnosis of a depressed mood
Treatment of choice for adjustment disorder focuses on psychotherapy that promotes coping skills and a return to function.
Attention-deficit hyperactivity disorder
- Clinical features
- Treatment
Somatic symptom disorder
- Clinical features
- Management
Anti-emetics that are also dopamine antagonists
Metoclopramide
Prochlorperazine
Promethazine
Anorexia nervosa
- Clinical features
- Treatment
- Complications
Neuroleptic malignant syndrome
- Signs/symptoms
- Precipitating factors
- Treatment
Catatonia
- Clinical features
- Management
Persistent depressive disorder (dysthymia)
- DSM-5
- Specifiers
Generalized anxiety disorder
- DSM-5 criteria
2. Treatment
Benzodiazepines should be reserved for non-depressed patients without a history of substance abuse who fail to respond to or cannot tolerate antidepressants.
Gender dysphoria
- Clinical features
- Management
Drug intoxication (Drug, class, clinical features)
- PCP
- LSD
- Cocaine
- Methamphetamine
- Marijuana
- Heroin
Secondary causes of acute-onset psychosis in children and adolescents
Bath salts
Amphetamine analogues
Cause severe agitation, compativeness, psychosis, delirium, myoclonus, and rarely, seizures.
Most distinguishing feature is prolonged duration of effect. Delirium and psychosis due to bath salts may last from days to weeks, whereas the effects of intoxication with other amphetamines or hallucinogens are usually of much shorter duration.
Not detected on routine tox screens
Normal aging versus Dementia
- Memory loss
- Word-finding difficulty
- Independence and functioning
Antidepressant classification and major drugs
- SSRI
- SNRI
- NDRI
- TCA
- MAOI
- Other
Metabolic effects of second-generation antipsychotics
- Metabolic syndrome
2. Highest-risk drugs
3. Monitoring guidelines
Assess BMI monthly
Fasting plasma glucose and lipids, blood pressure, and waist circumference assessed at baseline, 3 onths, then annually.
Tourette syndrome
- DSM-5
2. Treatment
Alpha-2 adrenergic receptor agonists: clonidine, guanfasine
Behavioral therapy: Habit reversal training (HRT)
First-line treatments for smoking cessation
Nicotine replacement therapy
Buproprion
Varenicline
Key features of DSM-5 personality disorders
- Paranoid
- Schizoid
- Schizotypal
- Antisocial
- Borderline
- Histrionic
- Narcissistic
- Avoidant
- Dependent
- Obsessive-Compulsive
Ramelteon
Melatonin agonist used for sleep onset insomnia
Demonstrated safety in older adults and requires o dosage adjustment
Delusional disorder
- Clinical features
- Differential diagnosis
- Treatment
Cognitive impairment in elderly patients
- Normal aging
- Mild neurocognitive disorder
- Major neurocognitive disorder (dementia)
- Major depression
Signs and symptoms of major depression
Differential diagnosis of DSM-5 anxiety disorders
- Social anxiety disorder
- Panic disorder
- Specific phobia
- Generalized anxiety disorder
Lithium toxicity
- Etiology
- Features
- Management
Eating disorders
- Anorexia nervosa
- Bulimia nervosa
- Bing-eating disorder
The binge-purge subtype of anorexia is distinguished from bulimia by body weight: Anorexia: Underweight (<18.5 kg/m^2)
Bulemia: Normal to overweight
LSD intoxication
Euphoria, hallucinations, subjective perceptual intensification, depersonalization, and allusions.
2 or more of the following signs are often present: Sweating, tachycardia, pupillary dilation, palpitations, tremors, poor coordination
3,4-Methylenedioxy-methamphetamine (MDMA) intoxication
Also known as ecstasy
Synthetic amphetamine with mild hallucinogenic properties.
Enhances euphoria, sociability, empathy, sexual desire
Trichotillomania
- DSM-5
2. Treatment
Antisocial personality disorder
- Clinical features
- Managment
Reaction formation
Transforming an unacceptable feeling or impulse into its extreme opposite.
