Psychiatry Flashcards
exhibit disordered thought content and thought process + illusion or hallucination, delusion, impaired reality orientation + impaired social and occupational functioning
Schizophrenia
positive symptoms for schizophrenia
hallucinations, bizarre behavior, delusions
negative symptoms for schizophrenia
flat affect, apathy, poor grooming, social withdrawal, anhedonia, poor eye contact, poverty of speech
Define paranoid schizophrenia
most common, characterized by persecutory or grandiose delusions or auditory hallucinations
define disorganized schizophrenia
characterized by disorganized speech or behavior and flat or inappropriate affect
define catatonic schizophrenia
include 2: motor immobility, excess motor activity that is w/o purpose, extreme negativism or mutism, peculiarly voluntary movement, echolalia, or echopraxia
define delusions
erroneous beliefs based on misinterpretation of reality, such as paranoia, ideas of reference, thought broadcasting, delusions of grandeur, delusions of guilt
define hallucinations
false perceptions in any of the sensory modalities (auditory, tactile, olfactory, visual)
define disorganized speech
unable to stay on topic, or provide a tangential response
Schizophrenia treatment
- hospitalization if SI, inability to care for self, or threat to others
- antipsychotics
- psychosocial treatment
aripiprazole (abilify)
atypical antipsychotic
clozapine
atypical antipsychotic
ADR: WBC agranulocytosis
risperidone
atypical antipsychotic
olanzapine (zyprexa)
atypical antipsychotic
quetiapine (seroquel)
atypical antipsychotic
lurasidone (latuda)
atypical antipsychotic
Examples of Typical Antipsychotics
thioridazine, chlorpromazine, mesoridazine, movindone, perphenazine, loxapine, trifluoperazine, thiothixene, haloperidol, fluphenazine, pimozide
Typical Antipsychotics ADR
anticholinergic, reduce seizure threshold, hypotension, agranulocytosis, QT prolong, wt gain, extrapyramidal symptoms
Describe extrapyramidal symptoms
dystonia - muscle spasm Parkinsonian - rest tremor, rigid Akathisia - restlessness tardive dyskinesia - slow movement neuroleptic malignant syndrome = emergency!!
why would you choose atypical antipsychotics over typical?
fewer extrapyramidal side effects
blocks dopamine and serotonin
this disorder meets criteria for major depressive episode, manic episode, or mixed + meets criteria for schizophrenia
schizoaffective disorder
Schizoaffective disorder
mixture of psychotic and mood symptoms
delusions or hallucinations lasting for 2 weeks w/o mood disorder symptoms
schizoaffective disorder treatment
second-generation antipsychotics
add mood stabilizer or antidepressant
psychosocial suport
this disorder is characterized by presence of nonbizarre delusions (situations that occur in real life for 1 month)
delusional disorder
this disorder has psychotic symptoms present for 1 day to one month, occurs after a catastrophic event
brief psychotic disorder
same symptoms as schizophrenia but symptoms last 1-6 months
schizophreniform
What are the 5 psychotic disorders?
schizophrenia schizoaffective disorder delusional disorder brief psychotic disorder schizophreniform
What are the 7 Somatoform disorders?
somatization disorder body dysmorphic disorder conversion disorder factitious disorder malingering hypochondriasis pain disorder
patient presents with vague physical complaints involving many organ systems, numerous visits to health care providers, no medical disorder is found
somatization disorder
treatment for somatization disorder?
regularly scheduled visits with health care provider
group and individual psychotherapy
this disorder is characterized by preoccupation with an imagined defect in physical appearance or exaggerated distortion of a minor flaw (often facial)
body dysmorphic disorder
this patient often visits dermatologist and not satisfied with physical appearance, age 15-30, female
body dysmorphic disorder
treatment for body dysmorphic disorder
serotonin drugs (fluoxetine, clomipramine) 10-12 weeks if depression is associated = treat
this disorder is characterized by 1+ neurologic complaints that cannot be explained clinically, not intentionally produced, most common = shifting paralysis, blindness, mutism, indifference to symptoms
conversion disorder
treatment for conversion disorder?
psychotherapy, hypnosis, anxiolytics (lorazepam), relaxation
patients intentionally fake symptoms of medical or psychiatric. motivation is to assume the sick role. seek hospital admission under different names
factitious disorder
treatment for factitious disorder
avoid unnecessary procedures
confront in nonthreatening way
psychotherapy
SSRI may reduce impulsive tendencies
deliberate production of physical or psychological symptoms, motivated by external gain. express vague, poorly defined symptoms = but say they cause great distress, injuries often self inflicted, uncooperative, symptoms improve when objective is met
malingering
preoccupation with the belief of having or fear of contracting a serious illness, no medical cause found, last 6 months and impair function
hypochondriasis
treatment for hypochondriasis
psychotherapy
SSRI
pain is reported in 1+ areas w/o any identifiable cause, impair functioning, not intentionally produced, chronic disorder
pain disorder
treatment for pain disorder
psychotherapy, behavioral therapy, pain control programs
NO ANALGESICS OR SEDATIVES
SSRI or TCA (may have some benefit)
What are the 6 mood disorder?
Major Depressive Disorder Bipolar I Bipolar II Dysthymic Cyclothymic Adjustment
What are the 4 mood episodes?
major depressive
manic
hypomanic
mixed
What are some depressive signs and symptoms?
depressed mood, anhedonia, excessive feeling of guilt, indecisiveness, lack of self-worth, sleep problems (insomnia/hypersomnia), cognitive problems, changes in appetite, decreased interest in sex, SI, chronic fatigue or decreased energy
What are some manic signs and symptoms?
inflated self-esteem or grandiosity, irritability, decreased need for sleep, pressure speech, flight of ideas, distractibility, impaired judgement - resulting in pursuit of pleasurable activities with a high probability of adverse outcomes
Major Depressive disorder diagnostic criteria
2 weeks
5+ symptoms
What are the 7 subtypes of MDD?
seasonal affective melancholia (severe) atypical (overeating, wt gain) substance-induced catatonic (movement) psychotic (delusions or hallucinations) postpartum (4 weeks after delivery)
Treatment options for MDD?
pharmacotherapy
electroconvulsive therapy
psychotherapy
how long should antidepressants be used when treating MDD?
4-6 weeks, maintenance should be >6 months (high relapse)
First line antidepressants for MDD?
SSRI (fluoxetine, paroxetine, sertraline)
-ADR: GI, HA, sexual dysfunction
do not combine with MAOI
SSRI examples
fluoxetine sertraline paroxetine fluvoxamine citalopram escitalopram
SNRI examples
venlafaxine (effexor)
duloxetine (cymbalta)
Serotonin receptor agonists and antagonists
trazodone
nefazodone
norepinhephrine-dopamine reuptake inhibitors
bupropion (wellbutrin)
-has low sexual ADR!
helpful for smoking cessation
TCA examples
block reuptake of serotonin and norepi doxepin nortriptyline imipramine desipramine clomipramine ADR: anticholinergic, orthostatic hypotension, cardiac toxicity, sexual dysfunction, wt gain
MAOI examples
selegiline tranylcypromine phenelzine isocarboxazid -risk for hyperadrenergic crisis (DIET) = cured meats, fish, beer, red wine, cheese (tyramine-free diet)
What is a modulator of norepi and serotonin and does not cause sexual dysfunction?
mirtazapine (remeron)
this disorder is characterized by the occurrence of 1+ manic episodes, often cycles with depression, manic episodes last 1 week, FHx
Bipolar I
Treatment for Bipolar I
mood stabilizers = lithium, valproic acid, olanzapine, carbamazepine
second generation antipsychotics = risperidone, aripiprazole, quetiapine, ziprasidone
Are mood stabilizers teratogenic?
yes
Lithium uses?
acute mania, bipolar depression, long term bipolar, impulse dyscontrol
Lithium MOA?
alters second messenger system, GABA, takes 2-4 weeks, monitor serum levels
Lithium ADR?
CNS: sedation, cognitive clouding, tremor ENDO: TSH Cardiac: sinus arrhythmia Renal: polyuria GI Wt gain
Valproic Acid Uses?
acute mania, long term bipolar, impulse dyscontrol, seizure disorders
Valproic Acid MOA?
increases GABA, takes 2-4 weeks, monitor serum levels, LFT first 6 months = can cause liver hepatotoxicity
Valproic Acid major ADR?
neural tube defects = spina bifida
agranulocytosos
pancreatitis
Lamotrigine
mood stabilizer
maintenance for bipolar I
Steven Johnson = ADR
other ADR: ataxia, blurred vision, diplopia, dizzy, n/v
Carbamazepine
mood stabilizer
ADR: agranulocytosis, pancytopenia, aplastic anemia
Oxcarbazepine
mood stabilizer/anticonvulsant
Describe bipolar II?
1+ depressive episode to hypomania (no manic or mixed)
hypomania = less severe, cause less social impairment, no psychotic symptoms
This disorder is chronic, persistent mild depression which is manifested by pessimism, brooding, generalized loss of interest, decreased productivity, feeling inadequate, social withdrawal. No psychotic or manic features.
Dysthymic disorder
patient is depressed mood for most of the day, for 2 years (1 year in children or adolescents). has not been without symptoms for >2 months
Dysthymic disorder
Treatment for dysthymic disorder?
antidepressants = SSRI
insight-oriented behavior and cognitive therapy
patients are described as moody, erratic, impulsive, somewhat volatile
mild bipolar for 2 years - recurring periods
cyclothymic disorder
Treatment for cyclothymic disorder?
mood stabilizers
antimanic drugs
psychotherapy
antidepressants
this disorder is characterized by maladaptive behavioral or emotional symptoms that develop within 3 months after a stressful life event. END within 6 months (often after divorce, leaving home)
adjustment disorder
TX: short-term treatment for insomnia, anxiety, depression
Personality Diroder Clusters?
A - mad (odd/eccentric)
B - bad (dramatic/emotional)
C - sad (anxious/fearful)
Cluster A example?
associated with psychotic
Schizoid
Schizotypal
Paranoid
Cluster B Examples?
associated with mood
antisocial
borderline
histrionic
narcissistic
Cluster C examples?
associated with anxiety
avoidant
dependent
obsessive-compulsive
This personality disorder is characterized by pervasive distrust and suspicion of others, anticipate harm and betrayal, reluctance to confide in others, quick to counterattack
paranoid personality disorder
Tx: individual psychotherapy, antianxiety med, or antipsychotics to decrease paranoia
this personality disorder is characterized by lifelong pattern of voluntary social withdrawal, quiet, have constricted affect, no desire for close relationships, indifferent to praise or criticism
Schizoid personality disorder
(schizoid = avoid)
Tx: group therapy and psychotherapy, low-dose short-term antipsychotics or antidepressants
This personality disorder is characterized by a pervasive pattern of eccentric behavior and peculiar thought patterns - viewed as strange and eccentric, magical thinking, not consistent with social norms
Schizotypal personality disorder
(no true psychosis - hallucinations or delusions = but can develop into schizophrenia)
Tx: psychotherapy, low dose antipsychotics (risperidone, olanzapine)
This personality disorder is characterized by an inability to conform to social norms, and a strong tendency to commit unlawful acts, 18 years old, disregard to the rules, lye, aggressive, endanger themselves
Antisocial personality disorder
Tx: psychothearpy
Reduce anxiety, impulsivity, aggression (SSRI, lithium, valproate, carbamazepine)
This personality disorder is characterized by an unstable and unpredictable mood, affect, and behavior, desperately attempts to avoid abandonment, cannot tolerate being alone but exhibit intense anger toward friends, instability in relationships/self-image/impulse control
Borderline Personality Disorder
Tx: dialectical behavior theraphy
Antipsychotics, SSRI, benzo, lithium
This personality disorder has individuals who are overly emotional, dramatic, and seductive, high degree of attention-seeking behavior, flamboyant, easily influenced by others, need to be center of attention
histrionic personality disorder
Tx: psychotherapy
antidepressants
anxiolytics
This personality disorder has individuals who have inflated self-image, pattern of grandiosity, need for admiration, and lack of empathy, self-centered, and low-self esteem, arrogant and entitled
Narcissistic personality disorder
Tx: psychotherapy is key
lithium = if mood swings
SSRI = if mood disorder present
This personality disorder has individuals who have an extreme sensitivity to rejection (inferior complex), see themselves as unappealing, desire relationships but avoid them b/c of anxiety produced by a sense of inadequacy, very sensitive to criticism, fear of rejection
Avoidant personality disorder
Tx: psychotherapy,
BB, SSRI, benzo
This personality disorder has individuals who have an enduring pattern of dependent, clinging, and submissive behavior, extremely needy, rely on others for emotional support and decision making, go to extreme lengths to seek another relationship
dependent personality disorder
Tx: psychotherapy
anxiolytics, antidepressants
This personality disorder is characterized by a pervasive pattern of orderliness (rules, lists, details), perfectionism, and inflexibility. tend to be rigid and cold, stubborn, not distressing to the patient (egosyntonic)
obsessive-compulsive personality disorder
Tx: psychotherapy
SSRI
2nd line = clomipramine (TCA)
What are the 6 types of anxiety disorder?
Generalized Anxiety Disorder Panic attacks and panic disorder OCD PTSD acute stress disorder phobias (specific or social)
This anxiety disorder is characterized by persistent, excessive anxiety regarding general life events that last for 6 months. not situational or episodic. restless, easy fatigability, sleep disturbance, muscle tension, difficulty concentrating, difficulty coping with anxiety
Generalized anxiety disorder
Tx: SSRI SNRI (venlafaxine) Buspirone (anxiolytic) Benzo - for short term behavioral therapy - relaxation techniques
Define panic attack?
period of extreme anxiety that peaks within 10 minutes, and declines after 30
experience palpitations, sweating, trembling, dyspnea, sense of choking, nausea, fear of losing control, fear of dying, numbness
Define panic disorder?
recurrent, unexpected panic attacks that occur abruptly and are accompanied by debilitating fear of having additional attacks
Treatment for panic disorder?
acute anxiety = benzo (alprazolam or lorazepam)
maintenance = SSRI (paroxetine) 8-12 months
CBT and exposure therapy
define obsessions?
persistent and recurrent thoughts, images, impulses that are intrusive and inappropriate, cause significant anxiety
Define compulsions?
ritualistic or repetitive behavior or thoughts that patients feel compelled to engage in to relive the anxiety caused by the obsessions
difference between OCD and obsessive-compulsive personality disorder?
OCD = egodystonic = distressing to the patient
personality disorder = not distressing
Treatment for OCD?
SSRI (sertraline, paroxetine, fluoxetine, citalopram) at high doses
+ desensitization
this anxiety disorder results from exposure or witnessing a traumatic event and is manifested by overwhelming sensations of helplessness, fear, horror, impair occupational or social functioning
sense of reliving the event, avoid talking about event/activities that remind of event, symptoms for >1 month
PTSD
Tx: SSRI (sertraline, paroxetine) x 6 months
insomnia = trazodone
psychotherapy
symptoms of this anxiety disorder occur within 1 month and last from 2 days to 1 month. often if victim of violent event, survivor of natural disaster, MVA
excessive anxiety or arousal, distressing event is reexperienced
acute stress disorder
Tx: SSRI
anxiolytics (lorazepam, clonazepam)
Define phobia?
irrational fear and persistent excessive anxiety when presented with an object or a situational event
What are the 5 types of specific phobias?
animal, natural environment, blood-injection-injury, situational, other
fear of social situations in which embarrassment or humiliation in front of other people may occur
public speaking, using public restrooms, eating in public
social phobia
intense anxiety about placing oneself into a situation in which an incapacitating problem could occur and no help would be available.
fear of public places, crowded places, bus/train
agoraphobia
Treatment for social phobia and agoraphobia?
SSRI = paroxetine, fluoxetine, sertraline SNRI = venlafaxine
can add benzo
can add BB (propranolol)
insight-oriented therapy, CBT
What are the 3 eating disorder?
Anorexia Nervosa
Bulimia Nervosa
Obesity
2 types of anorexia
restricting
binge eating and purging
Treatment of anorexia nervosa
restore nutritional state
behavioral thearpy, supervised weight gain programs
antidepressatns (amitripytyline, paroxetine, mirtazapine)
NO BUPROPRION = lower seizure threshold
2 types of bulimia
purging - self induced vomiting
nonpurging - excessive exercise or fasting
Define obesity?
BMI >30
recurrent episodes of binge eating 2days/week for 6 months
Treatment for obesity
behavioral modification therapy, underling depression (SSRI), surgical (gastric bypass, gastroplasty)
define substance dependence?
(within 12 months) substance use results in impairment and manifested with either tolerance, withdrawal, use of larger amounts, unsuccessful efforts to stop, more time spent attempting to acquire, impairment
define substance abuse
not met criteria for dependence = fail to meet home/school/work obligations, use in hazardous situations (car), legal problems
slurred speech, ataxia, facial flushing, erratic behavior, loss of inhibiton, and euphoria, unsteady gait, memory impaired = s/s of what?
alcohol intoxication
chronic alcohol abuse s/s?
acne rosacea, palmar erythema, hepatomegaly (fatty liver infiltration), testicular atrophy, gynecomastia
elevated gamma glutamyl transpeptidase, AST/ALT, LDH, MCV
alcohol withdrawal symptoms?
tremor/shakes/jitters 6-18 hr after cessation
tachy, n/v, DT, seizures
CAGE?
cut down, annoyed, guilty, eye opener
Wernicke-korsakoff syndrome is what?
thiamine deficiency
TRIAD = eye movement abnormalities, ataxia, mental confusion
Pharm options for alcohol abuse?
DAN
Disulfiram = cause nausea when etoh consumed
acamprosate = glutamate modulator
Naltrexone = opiate agonist = reduce high
Intoxication manifestations of opioid use are??
drowsiness, impaired concentration, bradycardia, hypotension, constricted pupils, slurred speech, flushing
withdrawal manifestations of opioid use are??
lacrimation, RHINORRHEA, sweating, awning, anxiety, HTN, DILATED PUPIL
Treatment for opioid use/abuse?
Naloxone
Methadone (u agonist)
Clonidine (alpha 2 agonist)
buprenorhpnie (opioid dependence)
Examples of stimulants?
caffeine, cocaine, amphetamines, psuedoephedrine, diet pills
Stimulant intoxication s/s?
agitation/aggression, impaired judgement, euphoria, eleved bp, DILATED PUPILS, hallucinations, transient psychosis
Withdrawal s/s of stimulants?
fatigue, HA, profuse sweating, muscle cramps, hunger
Treatment of stimulant abuse/use?
benzo = reduce agitation
Treatment for nicotine and tobacco?
bupropion
varenicline
This is a childhood disorder = hyperactivity, impulsivity, inattentiveness resulting in impairment before age 7
occur in 2 settings (home/school)
6 symptoms for 6 months
ADD/ ADHD
Treatment for ADD/ADHD?
CNS stimulant + behavioral thearpy
methyphenidate, dexmethypphenidate, emphetamine/dextroamphetamine
ADR: growth retardation, wt loss
non stimulant treatment for ADD?
atomoxetine = SNRI
This childhood disorder = pattern of behavior that involves violation of basic rights of others or of social norms. 3 of = aggression toward animal/people, destruction of property, deceitfulness, serious violation of rules
Conduct Disorder
like antisocial in adult
Treatment for Conduct Disorder?
environmental and behavioral modifications, family therapy
Stimulants = treat aggressive/assultive behavior
SSRI = reduce impulsivity and mood
This childhood disorder = 6 months of negativistic, hostile, defiant beahivor
4 of = frequent loss of temper, arguments with adults, defying adults rules, deliberately annoying others, easily annoyed, anger, resentment, blame others
Oppositional defiant disorder
Treatment for oppositional defiant disorder?
family intervention, individual psychotheraphy
This disorder is characterized by impaired social interaction, impaired communication, and repetitive stereotyped patterns of behavior and activities BEFORE AGE 3?
Autistic disorder
no smile or facial expression, fail nonverbal communication
This disorder is characterized by decreasing head circumference per height and weight + loss of previously learned behaviors, social interactions, and motor/language development. GIRLS
Rhett disorder
This disorder involves multiple motor and 1+ vocal tics for >1 year, common ages 3-8, after group A strept infection (PANDA)
sudden, rapid, recurrent, nonrhythmic (grunt/bark)
Tourette Disorder
physical signs of abuse?
any injury that cannot be adequately explained or is not consistent with the hx given
Burns = doughnut shaped, stocking-glove, symmetrically round
Bruise that form regular patterns
Retinal hemorrhage or hyphemia = shaken baby syndrome
Forms of Elderly abuse?
physical, sexual, psychological, financial, neglect, violation of basic rights