Psychiatry Flashcards
Differentiate anorexia nervosa from bullimia nervosa.
Anorexia: Distorted body image with self-imposed starvation. Characterized by weight loss of at least 15% of ideal body weight.
Bullimia: Binge eating + vomiting/laxatives/diuretics/exercise to extreme to lose weight. Patients tend to maintain weight near ideal range.
Define anorexia.
Lack or loss of appetite for food
Define classifications of anorexia nervosa from mild to extreme.
Mild: BMI = 17+
Mod: BMI = 16-16.9
Severe: BMI = 15 - 15.9
Extreme: BMI < 15
What is the diagnostic criteria for bulimia nervosa?
At least 1 binge/purge episode per week for 3 mos
Define classifications of bulimia nervosa from mild to extreme.
Mild: 1-3 episodes per week
Mod: 4-7 episodes per week
Severe: 8-13 episodes per week
Extreme: 14+ episodes per week
What are some common S/S associated with anorexia nervosa?
Emaciated, lanugo (soft/thin hair), bradycardia, amenorrhea/delayed menarche, osteoporosis
What lab abnormalities are common in anorexia nervosa?
Leukopenia, HypoK, HypoPhos, HypoCl, HypoCa, dec vitamin D, inc BUN, metabolic alkalosis, dec estrogen, inc cortisol, inc total cholesterol s/p inc HDL.
What is the primary goal in the treatment of anorexia nervosa?
Restore nutrition –> may require hospitalization if body weight < 20% expected.
What specialty typically manages treatment of anorexia nervosa?
Requires multi-disciplinary approach.
What medications may be used in the treatment of anorexia nervosa?
Anti-dep: amitryptaline, paroxetine, mirtazapine
Weight gain: olanzapine
What anti-depressant is contraindicated in the management of anorexia nervosa and why?
Bupropion –> dec seizure threshold
What ECG arrhythmia is most common in anorexia nervosa?
sinus bradycardia
Describe refeeding syndrome associated with anorexia nervosa and state which electrolyte abnormality is responsible.
Def: eintroducing nutrition too quickly
Caused by hypophosphatemia
What are common S/S associated with bulimia nervosa?
dental erosion, esophagitis, HypoCl, HypoK, HypoMg, HypoCa, metabolic alkalosis, salivary gland hypertrophy, elevated amylase, gastric distention
What is first line therapy in bulimia nervosa?
CBT
Which eating disorder is more likely to require hospitalization?
Anorexia
Which SSRI is approved for the treatment of bulimia nervosa?
Fluoxetine (Prozac)
T/F: Due to its severity, anorexia nervosa patients typically seek treatment more commonly than bulimia nervosa patients?
False: Bulimia seeks treatment more commonly
Describe the diagnostic criteria for major depressive disorder.
Depressed mood + anhedonia (inability to feel pleasure) with 5 or more assoc symptoms almost every day for 2 weeks
State the associated symptoms that are part of the diagnosis of major depressive disorder.
- Change in weight or appetite
- Change in sleep
- Change in psychomotor activity (agitation)
- Decreased energy
- Felling worthless, guilt
- Difficulty thinking or concentrating
- Recurrent thoughts of death/suicide
What treatment options are considered for major depressive disorder?
1st line: Psychotherapy
2nd line: SSRIs/SNRIs/TCAs, CBT
Last line: ECT
What are some risk factors for suicide?
Psychiatric illness, previous suicide attempts, never been married, military service, childhood abuse, family history of suicide, and access to weapons.
T/F: Men are more likely to attempt suicide.
False: Women are 2x more likely to attempt suicide but men are 3x more likely to be successful.
What should be included in the assessment of a person with SI?
Lethality of the patient’s medication regimen –> SSRIs are preferred in patients with depression and suicide risk s/p their low lethality in overdose.
Describe the diagnostic criteria for generalized anxiety disorder.
Excessive anxiety or worry more days than not in a 6 month period plus 3 or more associated symptoms.
State the associated symptoms that are part of the diagnosis of generalized anxiety disorder.
Fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA
What options may be considered in the management of generalized anxiety disorder?
- SSRIs (paroxetine and escitalopram( or SNRIs
- Buspirone - no sedation, takes weeks for effect
- BZDs, BBs for short term effect
- Psychotherapy
Describe the diagnostic criteria for panic disorder.
Recurrent, unexpected attacks (at least 2) not related to trigger. Panic attack followed by concern of more attacks, worry about implication of attacks, or significant change in behavior related to attacks
What is required to make a diagnosis of panic attack?
At least 4 of –> palpitations, trembling, sweating, choking, SOB, chills, dizzy, nausea, hot flashes, paresthesias, fear of dying, losing control.
What is used in the management of a panic attack?
BZD
What is used in the long term management of panic disorder?
SSRIs and CBT
What lab values must be evaluated before making a diagnosis of panic disorder?
TSH, CBC, CMP
What substance use disorder is most often associated with panic disorder?
Alcohol Use Disorder
Describe general characteristics of phobic disorders.
Irrational fear that is known to patient and causes an immediate response upon exposure and may even result in a panic attack.
What is required to diagnose a phobic disorder?
Response to stimuli interferes with daily routine, social functioning, or occupational functioning and is present for at least 6 months.
Define agoraphobia.
Fear of places and situations that might cause panic, helplessness, or embarrassment.
What are treatment options for phobic disorders?
SSRIs (1st line pharm), BZDs, TCAs, BBs
Best therapy –> systemic desensitization through exposure therapy.
Describe the criteria required to doagnose PTSD.
Traumatic event that is directly experienced or learned event of close friend/family. Symptoms for 1+ month in each of the following –> 1+ intrusive symptom, 1+ avoidance, 2+ negative alterations in cognition/mood, and 2+ changes in arousal/reactivity related to event.
Give examples of intrusive symptoms, avoidance symptoms, negative alterations, and arousal/reactivity changes related to PTSD.
Intrusive: dreams, flashbacks, psych/phys response to stimuli related to the event.
Avoid: Memories, thoughts, feelings, external reminders
Neg Alt: Can’t remember pieces of event, distorted blame about event, detachment, inability to experience positive emotions, etc.
Arousal: irritability, self-destructive behavior, hypervigilence, difficulty concentrating, insomnia
What is used in the treatment of PTSD?
SSRIs first line, other –> MAOIs, TCAs, CBT
Differentiate acute stress disorder from PTSD.
Similar S/S but occur within one month of event. 1st line Tx is psychotherapy/CBT
Define Bipolar I disorder.
Occasional major depressive episodes with at least 1 manic episode.
Define a manic episode.
Marked by grandiosity, decreased need for sleep, pressured speech, flight of ideas, easily distracted, risk taking behavior, increased goal directed activity or psychomotor agitation lasting at least 1 week.
What is the biggest risk factor for bipolar I disorder?
Family Hx
What is the treatment for bipolar I disorder?
Lithium or 1st/2nd generation anti-psychotic.
Define bipolar II disorder.
Major depressive episodes with HYPOMANIA
Define hypomania.
Similar to mania but less severe (society may perceive hypomania to be beneficial) and needed to only be present for 4 days.
T/F: Patients with bipolar I disorder are at higher risk of suicide.
False: Bipolar II carries higher risk of suicide attempts and greater lethality per attempt.
What is the treatment for bipolar II disorder?
Same as bipolar I –> lithium or anti-psychotic.
Describe S/S associated with chronic alcohol abuse.
acne rosacea, palmar erythema, hepatomegaly, dupuytren contracture (thickened skin at base of fingers), testicular atrophy, gynecomastia
What serum lab changes are seen in AUD and which is the earliest change?
Inc: GGT (earliest), AST, ALT, LDH, MCV
Dec: RBC volume, LDL, BUN
Describe the progression of alcohol withdrawal over time.
8-18 hours: shakes and jitters
24-48 hours: seizures
48-96 hours: DTs –> disorientation, agitation, hyperthermia
What is the treatment for severe alcohol withdrawal?
BZDs, antipsychotics, glucose, thiamine, fluids
What pharmacologic options are available to treat AUD?
Disulfiram and naltrexone
What is the risk of treating AUD with disulfiram?
Intake of any alcohol on this medication will cause severe illness.
What determines the potency of cannabis products.
Ratio of THC to cannabidiol in the substance
How long after use does THC remain detectable in urine?
1 month
When does the withdrawal period start and stop for THC?
Starts within 24-48 hours after last use and peaks on day 4.
Describe S/S of THC withdrawal and state how it is treated.
S/S: malaise, irritability, insomnia, night sweats, GI
Tx: usually not needed –> may use anxiolytics
Describe the S/S of severe PCP intoxication and state the first line treatment.
S/S: violent behavior, horizontal and vertical nystagmus, auditory hallucinations.
Tx: BZDs
What is a common sequelae of inhalant use disorder and what S/S is seen to indicate it?
Often see an erythematous rash around the mouth s/p contact dermatitis to the chemicals in the inhalant. May lead to a secondary bacterial infection.
State some common S/S of inhlant use other than infectious sequelae.
Mood swings, HA, facial flushing, N/V, anorexia, cough, unusual breath or body odor, tachycardia, slurred speech.
What are the long term effects of inhalant use?
kidney, liver, and neurological degeneration
What are the classic S/S of opioid intoxication?
Miosis, respiratory depression, CNS depression
Name and describe treatment options to manage opioid dependence.
Methadone: ultra-long acting opioid agonist
Naltrexone: long acting opioid antagonist
Buprenorphine: mixed partial agonist and antagonist
What complications are associated with BZD withdrawal and what is the treatment:
S/S: seizure, cardiovascular collapse, death
Tx: long acting barb or BZD
What is the treatment for severe stimulant intoxication?
BZD and antipsychotic
What are the S/S associated with stimulant withdrawal.
Fatigue, depression, HA, profuse sweating, muscle cramps, hunger
What is the most common SUD in the US?
tobacco/nicotine
What comorbid conditions decrease the success rate of smoke cessation?
Alcohol or other SUD
Describe pharmacologic options available in the treatment of nicotine dependence.
NRT: patch, gum, lozenge –> cheap but less effective
Buproprion: anti-depressant that blocks DA reuptake
Varenicline (Chantix): dec cravings as partial alpha-2 agonist –> recently pulled from market
Nortriptyline (TCA: 2nd line pharm therapy
