Psychiatry Flashcards
Are fixed beliefs even with evidence to disprove belief.
Delusions; trump supporters are delusional
Is marked decreased in reactivity to the environment, usually patients maintain a rigid bizzare posture
Catatonia
What are negative symptoms?
The absence of pleasure (ahendonia), the absence of expression (flat), the absence of self motivation (avolition), the absence of interest in social engagement (asociality), speech poverty (alogia)
Delusional disorder criteria
The patient must have one or more delusions for a month or longer, but no other psychotic symptoms. Apart form the delusion this patient seems relatively normal.
Schizophreniform criteria
The patient presents with two or more of the following; delusions, hallucinations, and disorganized behaviors, and or negative symptoms for up to 6 months
Schizophrenia criteria
The patient presents with two or more of the following delusions, hallucinations, disorganized behaviors, and or negative symptoms for > 6 months
Brief psychotic disorder criteria
The patient presents with at least one of the following positive symptoms; delusions, hallucinations, and disorganized behaviors for up to. Symptoms are at least present for one day, but symptoms do not extend past one month. Patient should resolve fully to their baseline.
An MRI of the head of a schizophrenic patient may show enlarged cerebral ventricles like what other pathology?
Alzheimers
This type of thought pattern deviates from topic to topic, but patient will eventually return to the original topic.
A –>B –>A; this is circumstantial, think of circum as in we always get back to original point
This type of thought pattern does not come back to the original topic. The patient seems to be going on a rant. The ideas and thought are organized
Tangential, patient essentially goes on tangent after she/he switches the subject.
This type of thought pattern the patient jumps from topic to topic with well organized sentence structure an ideas
Trump’s Loose association
This type of thought pattern there are no connecting ideas mid sentence there can me a change in topic so the idea and the thought processes aren’t well developed.
Flight of ideas
Creation of new words with made up meanings
Neologisms
Immediate uncontrolled repetition
Echolalia
When a person mid-sentence stops speaking.
Thought blocking
Schizoaffective criteria
A period of mood episode (depression/mania) and delusions or hallucinations for two or more weeks without mood episodes.
Substance/medication induced psychosis criteria
Presence of one or both hallucinations or delusions, did the symptoms develop after substance use and is the substance capable of causing hallucinations and or delusions?
Psychotic disorder due to another medical condition criteria.
There are hallucinations and or delusions, there is evidence that there is a pathology that causes the latter symptoms, the symptoms are not explained via another mental disorder
Catatonia associated with another mental disorder criteri
1st generation of anti-psychotics
Chlorpromazine, haloperidol, droperidol, fluphenazine
What is the mechanism of action of 1st generation anti-psychotics?
The inhibit the positive symptoms
What is EPS?
Extra-pyrimidal symptoms. This includes dystonia, akathisia, tardive dyskinesia, and parkinson like symptoms. “PARK DATE,” to remember EPS symptoms
What is dystonia? What is the treatment?
Involuntary muscle contractions, benztropine or diphenhydramine
What is akathisia?What is the treatment?
Restlessness, try lowering the dose of anti-psychotic no resolve beta blocker or benztropine
What is tardive dyskinesia? What is the treatment? What is the treatment?
Repetitive involuntary slow purposeless movements ( sticking the tongue out or smacking) that can occur months after starting medical therapy.
What is treatment for a patient taking antipsychotics and the develop parkinson like symptoms?
Benztropine
What are the second generation anti-psychotics?
Olanzapine, paliperidone, ziprasidone, iloperidone, aripripazole, quetiapine.
What is the MOA of second generation antipsychotics?
Treat both positive and negative symptoms
What are some of the side affects of second (atypical) anti-psychotics
Hypermetabolic syndrome, agranulocytosis
For patients that are non-compliant with schizophrenia medications what is an alternate options for medical therapy?
Long acting depot (haloperidol or other second generations)
A 45 yo patient presents to the ED after he was found on the floor with marked rigidity, temperature of 102, and altered mentation. The patient has a history of schizophrenia. What is the treatment for his current state?
Dantrolene
Which drug is used for treatment resistant psychotic disorders?
Clozapine, resistance means the patient has tried at least two drugs for a 6 week duration.
These drugs have an increased risk for developing a hyper-metabolic state.
olanzaipine and clozapine
These drugs are the mood stabilizers
VAL; valproic acid, anti-psychotics, and lithium
Which anti-psychotic can cause agranulocytosis?
Clozapine
What are the major side affects of lithium?
It can cause hypothyroidism and nephrotoxicity
What is a side affect of riepserdone
Gynecomastia
Major depressive disorder criteria?
The patient must have 5 or more of these symptoms for greater than two weeks. Change in sleep, interest, guilt, energy, concentration, appetite,Psychomotor (dyskinesia) suicidal ideation
What are the SSRI medications?
Citalopram, escitalopram, fluoxetine, fluvoxamine, sertaline, paroxetine
What are the common side affects of SSRI’s
Erectile dysfunction, suicidal ideation
What are the SNRI medications?
Venlafaxine and duloxetine
What are the side affects of trazadone?
Priapism and sedation
What is a side affect of mirtazipine?
Weight gain
Bipolar disorder 2 criteria
The patient does not have mania
Disruptive mood regulation disorder criteria
For a year more Persistent outburst out of proportion to the event. The outbursts occur 3 or more times a week and the mood between outbursts are irritable or angry.
Persistent depressive disorder criteria
Symptoms must be present for two years or more. The patient has not been without symptoms for longer than two months or longer The patient has a depressed mood throughout the day daily.
Premenstural dysphoric disorder criteria
Must have five of the following symptoms the week prior to menstruation mood swings, irritability, depressed mood, anxiety.
Substance/medication induced depressive disorder criteria
Can not be explained by other depressive disorders. The drug upon consumption or withdraw has the ability to cause depressive symptoms.
Bipolar 1 diagnostic criteria
Patients diagnosed with bipolar 1 should have an episode of mania (elevated mood, activity, energy). During these episodes the patient can have “DIGFAST,” distractibility, impulsivity, grandiosity, flight of ideas, activity, sleep deficit, and talkitive. These symptoms can be severe and require hospitilization
What is the diagnostic criteria for PTSD?
The patient was exposed to life threatening or traumatic event and now
1) experiences intrusive thought, dreams, and or flashbacks related to the event.
2) avoids certain situations to prevent retraumatization
3) the patient cannot recall details of the event
4) Pt may have irritable behavior, be more hypervigilant
If this occurs for greater than a month it is referred to as PTSD
What is the diagnostic criteria for acute stress disorder?
The patient was exposed to life threatening or traumatic event and now experiences (PTSD criteria), but the timeline is between 3-days and up to a month. After that time frame it is called PTSD.
