Psychiatry Flashcards
First line management of an acute panic attack
Benzos like alprazolam after other life threatening conditions have been ruled out
First line management of panic disorder
SSRI like sertraline, citalopram, fluoxetine, adding cognitive behavioral therapy to this is most effective
Agoraphobia definition
Intense fear or anxiety about being in places or situations from which escape or obtaining help may be difficult and causing significant social or occupational dysfunction, managed best with CBT and SSRIs
Adjunctive medication for generalized anxiety disorder
Buspirone is ann adjunct to SSRI’s and does not cause sedation
Management of specific phobias
Exposure and desensitization therapy
Only antidepressant approved for treatment of bulimia
Fluoxetine
Buproprion function
Major depressive disorder and smoking cessation aid, has less sexual dysfunction and weight gain compared to SSRI’s
Seratonin syndrome treatment (mild vs moderate)
Mild is supportive care, moderate is cyproheptadine (serotonin antagonist)
Greatest risk factor for bipolar i disorder
Family history
Acute mania most effective treatment
Antipsychotics like risperidone or olanzapine OR mood stabilizers like lithium and valproic acid
Is lithium contrainidcated in pregnancy?
YES, and it should be used with caution in renal disease alongside nsaid or diuretic use
Hypomania (characteristic of bipolar ii alongside major depressive disorders) differs from mania of bipolar i how so?
It doesn’t require hospitalization, is not associated with marked social/occupational function or psychotic features
Cyclothymic disorder definition
Similar to bipolar II but less severe, approximately 1/3 will eventually develop bipolar disorder
Highest risk for suicide in the US
Elderly white men
Oppositional defiant disorder vs disruptive mood dysregulation disorder
-ODD is associated with intent behind behavior, while children with DMDD do not do it on purpose and may feel remorse after outburst
Management of conduct disorder, oppositional defiance disorder, disruptive mood dysregulation disorder
Behavioral modification, community and family involvement, parental training
Oppositional defiant disorder vs conduct disorder
-Oppositional defiant disorder sees children generally defiant to authority but is NOT associated with physical aggression, violating other’s basic rights, or breaking laws
Dissociative identity disorder
Presence of 2 or greater distinct identities or state of personalities that take control of behavior, gaps in recall of events may occur throughout daily events, may be associated with history of sexuala buse
Binge eating disorder differs from bulimia in that…
…it lacks compensatory behaviors like purging or restriction
Weight of bulimia vs anorexia patients
Bulimic patients can usually maintain a normal weight or are overweight while anorexia is failure to maintain a normal body weight
Highest mortality of any psychiatric condition
Anorexia nervos
Difference between OCD and OCPD
OCD is ego dystonic (causes distress to patient and their worldview) while OCPD is ego syntonic (the patient doesn’t see anything wrong with their behaviors, OCPD is preoccupation with order, details, perfectionism without obsessions or compulsions
OCD treatment
CBT and SSRI first line pharmacotherapy (paxil is best maybe?)
Trichotillomania treatment
CBT habit reversal therapy
ADD is highly associated with what other comorbid condition?
Conduct and oppositional defiant disorders
Diagnostic criteria for ADD
-symptom onset before 12 years of age and present for at least 6 months, musc occur in 2 settings (home and school), must have at least 6 inattentive and 6 hyperactive/impulsive symptoms
Management of ADD (3)
- First line is stimulants (methylphenidate, amphetamine)
- nonstimulants like atomoxetine (norepi reuptake inhibitor) has similar efficacy and adverse profile and is good alternative
- alpha agonists like guanfacine and clonidine are options as adjuncts
Symptoms of autism spectrum disorder
Symptoms recognized between 12-24 months, social interaction difficulties, impaired communication, restricted, repetitive, stereotyped behaviors
Schizoid personality disorder definition
Lifelong pattern of voluntary social withdrawal and anhedonic introversion, loner introverted hermit like behavior managed with psychotherapy first line
Schizotypal personality disorder definition
Characterized by odd, eccentric, bizarre behavior and thought patterns suggestive of schizophrenia but without psychosis (no delusions or hallucinations), has magical thinking, distorted cognition and reasoning, first line management is psychotherapy
Borderline personality disorder definition
Unstable unpredictable mood, self image, and relationships, has intense fear of abandonment, intense reactions disproportionate to event, impulsivity in self damaging behaviors, CBT is management
Avoidant personality disorder definition
Social inhibition due to intense fear of rejection affecting daily lives, timid, shy, lacks confidence, unwilling to interact with others unless certain of being liked, inferiority or inadqueacy complex, averseness to participate in new activiites for fear of rejection or embarassment, psychotherapy is management
Dependent personality disorder definition
Characterized by inability to assume responsitiblity, dependent or submissive behavior, fear of being alone and difficulty making day to day decisions, needing to be taken care of, clingy or needy behaviors, managed with psychotherapy
Delusional disorder definition and how is it managed?
Fixed belief despite evidence to contrary, either bizarre or non bizarre (feasible but highly unlikely), without other psychotic symptoms or significant impairment in function
Atypical 2nd generation antipsychotics first line medical management
Schizophrenia vs schizophreniform vs schizoaffective disorder vs brief psychotic disorder
Schizophrenia is characterized by positive symptoms, negative symptoms, grossly disorganized or catatonic behavior for at least six months, schizophreniform is between 1-6 months, schizoaffective disorder is schizophrenia plus a mood disorder (major depressive or manic episode), brief psychotic disorder is 1 psychotic symptom with onset and remission <1 month!!!
Most common hallucination in schizophrenia, most common delusion types
Auditory, persecutory or grandiose
Imaging findings of schizophrenia (not diagnostic criteria)
Ventricular enlargement and decreased cortical volume and grey matter
First and second line management of schizophrenia
Second gen antipsychotics like risperidone, olanzapine, quetiapine, aripiprazole, clozapine is not used first line but is the most effective for treatment resistant psychosis
First generation antipsychotics like haloperidol can be used but increases risk of extrapyramidal symptoms or neuroleptic malignant syndrome
Emergency medication for agitated acute psychosis
Haloperidol or IM olanzapine
Management of acute dystonia reaction
Diphenhydramine or benztropine (cogentin, antitremor for parkinsons)
Neuroleptic malignant syndrome management
Prompt discontinuation, supportive care, dopamine agonists or dantrolene (also used for malignant hyperthermia)
Prazosin
Anti hypertensive and urinary retention medication alpha 1 blocker that also is sometimes used for nightmares in PTSD management
Adjustment disorder definition
Maladaptive emotional or behavioral reaction to an identifiable stressor that causes disproprotionate reponse than would normally be expected within 3 months of the stressor and usually resolves within 6 months of the stressor, psychotherapy is initial management
Somatic symptom disorder vs functional neurological disorder (conversion disorder) vs illness anxiety disorder vs factitious disorder vs malingering
Somatic symptom disorder - physical symptoms in at least 1 body symptom with no cause on workup plus no intentional falsification, often vague but disruptive to individuals daily life
Functional neurlological disorder (conversion disorder) - neurologic synmptoms or deficits (sensory or motor) with no cause on work up often preceded by a traumatic event and has no intentional falsification
Illness anxiety disorder - Preoccupation that one has an undiagnosed serious illness with no intentional falsification that can cause maladaptive behaviors for at least 6 months
Factitious disorder - Intentional falsification of symtpoms for primary gain (desire to be sick or have sympathy)
Malingering - Intentional falsification of symptoms for secondary external gain (money, shelter, etc)
Varenicline use
Blocks nicotine receptor reducing nicotine activity, partial agonist that mimicks the effects of nicotine reducing reward effect and prevent withdrawal symptoms, therapy should begin 1 week prior to quitting smoking and be continued for 4 motnhs after, can see adverse effects like headache, nausea, increased suicidality or rage
Management of alcohol withdrawal
IV benzodiazepines, hospitalization as can be fatal, iv fluids, thiamine
First line therapy for narcolepsy
Modafinil (stimulant that promotes wakefulness early into evening)
