Psychiatry Flashcards
People with hepatic encephalopathy should be treated with ____________ if they develop agitation.
Haldol
More effective than benzos
In patients who are partial responders to max dose of antidepressants, consider ____________.
adding another agent (such as bupropion, antipsychotics, etc)
What is the timeline for postpartum blues?
5-14 days
If you see a woman with postpartum depression beyond 14 days you need to manage as postpartum depression.
What are the guidelines for discontinuing antidepressants in the following patients?
- First episode of major depression, now in complete remission
- Second episode of major depression (also for those with a strong family history or a suicide attempt)
- Three or more episodes of depression
- Discontinue 6 months after remission if they continue to be stable
- Continue for 1-3 years after remission
- Continue indefinitely
True or false: interpersonal psychotherapy is the first-line treatment for borderline personality disorder.
False
Interpersonal psychotherapy is one of the first-line treatments for depression. Dialectical behavioral therapy (DBT) is the first-line treatment for borderline personality disorder. DBT focuses on emotional dysregulation and self-injurious behaviors.
A patient presents 3 weeks after starting an SSRI with nausea and anxiety. He says his depression is getting better. What should you do?
Reassess in 3 weeks.
Anxiety and GI distress are common early side effects of SSRIs, but they usually get better with tolerance. Sexual side effects typically do not develop tolerance.
Given that his depression is getting better and that he is still before the 6-week mark when his tolerance should be expected to be starting, it’s reasonable to wait and reassess then.
Which medications do you need to avoid in someone taking lithium?
- Thiazide diuretics
- ACEi, ARBs, aldosterone receptor antagonists
Drugs that can affect thyroid function should also be used cautiously.
Is hypothyroidism an indication to stop lithium?
Not necessarily.
Hypothyroidism from lithium can be easily treated with levothyroxine. If someone has bipolar disorder and is getting started on lithium, then they likely have significant psychiatric distress. Lithium is still one of the best options for treatment.
Tourette’s syndrome is frequently associated with what two other psychiatric disorders?
ADHD and OCD
What are some of the distinguishing features of borderline personality disorder and histrionic personality disorder?
Both are characterized by extreme, rapid mood swings, manipulative behavior, and splitting. Borderline personality disorder presents with suicidality, self-injurious behavior, and chronic identity crisis.
Review the differences between normal grief and depression.
Grief:
- Self-esteem preserved
- Sadness/hopelessness revolves around the lost loved one
- Minor hallucinations involving the loved one
- Suicidal thoughts only pertaining to joining the lost loved one
Depression:
- Sadness pervasive
- Feelings of worthlessness
- Major psychosis can be present
- Generalized suicidality
Review the difference between capacity and competence.
Capacity is a moment-to-moment clinical assessment of the patient that changes by scenario (such as from intoxication). Competence is a field property that is determined by a court (such as from a developmental impairment).
What are the agitation doses of ketamine, both IM and IV?
IM: 5 mg/kg
IV: 1-2 mg/kg
Review verbal de-escalation strategies.
- Establish one main point of contact. Multiple voices are overwhelming and frustrating.
- Identify their wants and needs by listening closely to the person and use their words to show them you understand.
- Set clear limits when people are being provocative or threatening.
- Debrief the staff dealing with them to show that you understand and are leading the situation.
- Address basic needs: get them a blanket, food, water.
- Have them in a quiet, private room.
What medicine is Geodon?
Ziprasidone
