Psychiatry Flashcards
Boys>girls
lack peer relationships, poor eye contact, & social smile.
Absent or bizarre speech, repetitive behaviors (stacking) , injurious behavior to self or others.
Autistic
Tx: Improve ability to develop relationships, attend schools, & achieve independent living.
Behavioral modifications, ANTIPSYCHOTIC Meds if aggressive.
Disorder
Girls> Boys;
Progressive encephalopathy, microcephaly, hand-wringing, loss of speech, ataxia, psychomotor retardation.
Rett Disorder
Tx: symptomatic, behavior therapy for self injurious behavior, physiotherapy for muscular def.
Boys> girls
Normal development for 2 yrs & then regressions.
Loss of language, social interaction, motor, bladder function. Repetitive/stereotyped behaviors.
r/o infection then r/in CDD.
Childhood Disintegrative Disorder
Tx: behavioral modification, develop relationships, attend school, achieve independent living
Boys> Girls.
Social problems. No intellectual deficits. Preoccupied with rules.
Asperger Disorder
Tx: Improve social relationships with others
Inattention, short attention span or hyperactivity that interferes with daily functioning
Usually appears before age 7, must be present for > 6 mos. May persist in adulthood
Must be in 2 areas (home &outside of home)
Comorbid w/learning disability.
ADHD
Tx: Methlyphenidate & dextroamphetamine
SE: insomnia, decreased appetite and headache
2nd line: atomoxetine (norepinephrine reuptake inhibitor)
Argues often, loses temper, easily annoyed, blames other for their mistakes, tends to have problems with authority figures. Justifies behavior as response to others actions
Oppositional Defiant disorder
Tx: Teach child management skills . No pharmacological treatment.
Leads to Anti-social Personality disorder
Persistent behaviors where rules are broken, cruelty to animals, bullying, fighting, using weapons.
Vandalize and destroy property, set fires, steal items from others or lie to obtain good from others.
Conduct Disorder
Tx: behavior with giving rewards for normal behaviors
Aggressive? Give antipsychotic meds.
Characterized by onset of multiple tics. Lasting > 1 yr.
Facial and neck muscles most commonly involved.
Vocal tics include grunting, coughing, &throat clearing.
Boys> girls; begins at age 7
Tourette Disorder
Tx: Dopamine antagonists- antipsychotics medications (Risperidone)
At least 2 wks of symptoms.
Depressed mood/Anhedonia + 4 of the following
Depressed mood most of the day, weight changes, sleep changes, fatigue, poor concentration, thoughts of death and worthlessness and psychomotor disturbance.
r/o medical causes: Thyroid hormone,Parkinson and dementia
Major Depression
Tx: SSRI (Fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
Increase the dose of SSRI
Psychotherapy: w/goal of teaching patients to identify negative thoughts
SSRI +MAOI
Serotonin Syndrome
Depression + Neuropathic Pain
Desvenlafaxine
Depressed + fears weight gain
buproprion
Manic symptoms that last at least 1 week. Cause significant distress in level of functioning.
Elevated mood, increased self-esteem, distractability, pressured speech, decreased need for speech.
Increase in goal directed behavior, racing thoughts, excessive involvement in pleasurable activities.
Bipolar Disorder
Tx:
Acute Mania: Lithium, Valproic Acid, Atypical Antipsychotics
Severe symptoms consider: atypical antipsychotics: shorter onset of action
Bipolar Depression: Lithium, Lamotrigine
Compromised Kidneys? DON’T USE LITHIUM!
Depressed mood for most of the day.
Symtoms must be present for > 2yrs.
Dysthymia
Tx: antidepressant medications and psychotherapy
Hypomanic episodes & mild depression. Symptoms present for > 2 yrs.
Cyclothymia
Tx: Lithium, valproic acid, carbamazepine, Psychotherapy
Increased sleep, weight, and appetite.
Moods tend to be worse in evenings & pts may complain of extremities feeling heavy
Atypical Depression
Tx: SSRI or MAOI
Weight gain, increased sleep, lethargy
Seasonal Affective Disorder
Tx: Phototherapy, and bupropion
Onset : immediate birth up to 2 wks. Sadness, labile mood, tearfulness. Love baby lots.
Baby Blues
Tx: supportive
Onset 1- 3 mos after birth.
Depressed mood, weight changes, sleep disturbances, & excessive anxiety, may have neg feelings toward baby.
Depression
Tx: Antidepressant
Onset 2-3 wks after birth.
Wants to harm baby.
Depression, delusions, and thoughts of harm.
Psychosis
Tx: antipsychotic med, lithium, possibly antidepressant
No functional impairment then don’t treat.
Begins after the death of loved one
Sadness, worrying, irritability, sleep difficulties, poor concentration, tearfulness
Bereavement
Tx: supportive psychothearpy
TCA (-triptyline)
Side Effects
Hypotension, Dry mouth, Constipation, Confusion, Arrhythmia, Sex SE, Weight gain, GI disturbance
MAOI Side effects
Phenelizine, Isocaboxiazid, tranylcypromine
Monitor diet
Causes HTN
SSRI Side effects
Fluoxetine, paroxetine, sertraline, citalopram, Escitalopram, Fluvoxamine
Headaches, weight changes, sexual SE, GI disturbances
SNRI Side Effect
Venlafaxine, Duloxetine, Desvenlafaxine
HTN, Blurry vision, weight changes, sexual side effects, GI
Bupropion Side Effect
Seizures
Trazadone Side Effect
Priapism
Mitrazapine Side Effect
Weight gain and sedation
Lithium Side Effect
Tremors, weight gain, GI, nephrotoxic, diabetes, leukocytosis, teratogenic
Lithium Toxicity
Confusion, ataxia, lethargy, abnormal reflexes
Valproic Acid SE
Tremors, weight gain, GI, alopecia, teratogic, hepatotoxic
Toxicity: hyponatremia, coma death
Lamotrigine SE
Stevens-Johnson Syndrome
ECT SE
Headaches, transient memory loss, single most effective treatment
Agitation confusion, hallucination, hypomania. Sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering, tremors, myoclonus.
Serotonin Syndrome
Tx: STOP THE MEDICATION. Symptomatic treatment of fever, nausea, vomiting. Cyproheptadine (serotonin antagonist)
Schizophrenia Treatment
Acutely psychotic- hospitalize-
Emergency situation give olanazpine and ziprazidone. Haloperidol was worse SE
Atypical antipsychotics
Noncomplaint with meds give long acting risperidone.
No response to trial of typical or atypical medications: Clozapine
Acute Dystonia
Hours to days
Muscle Spasms
Tx: Benztrophine, trihexphenidyl, diphehydramine
Akathesia
Weeks
Inability to relax, restless
Tx: reduce the dose, give beta blockers, switch to atypical antipsychotics
Tardive Diskinesia
Rare before 6 months
Abnormal involuntary movement esp perioral
Tx: Atypical antipsychotic, clozapine least risk
Neuroleptic Malignant Syndrome
Not time limited, muscular rigidity, fever, autonomic changes
Tx: Dantrolene or bromocriptine
Nonbizarre delusion >1 month, & no impairment in level of functioning
Hallucinations are not present
Delusional Disorder
Tx: Atypical Antipsychotics: First line
Psychotherapy can help pts feel things are safer than they believe
Dread and Doom
Diaphoresis, SOB, nausea, dizziness, trembling, chest pain, fear of dying, chills, dissociative symptoms, palpitations, paresthesias
r/o MI, thyroid, hypoglycemia, cardiac disease
Lasts
Panic Disorder
Tx: SSRI, typically (Fluoxetine, paroxetine, sertraline)
Benozdiazepine- taper the dose down to monitor
Behavioral therapy
GAD Treatment
Busiprone
Panic Attack
Alprazolam
Specific or Social Phobia Treatment
Tx: behavioral modification techniques, Systematic desensitization. Relaxation techniques (breathing guided imagery)
Performance anxiety
beta-blockers.
Given 30 mins to hr before performance.
Affect the pts level of functioning.
Obsessions: thoughts that are intrusive, senseless, & distressing, thus increasing anxiety.
Compulsions: neutralize the thoughts they are rituals
Young pts; men=women, coexist w/tourette disorder
OCD
Tx: SSRI: treatment of choice (Fluoxetine, paroxetine, sertraline, citalopram, or fluvoxamine)
Behavioral therapy –exposure therapy
Symptoms: Increased startle, hypervigilance, sleep disturbances, concentration issues, anger outbursts.
Symptoms last > 1 mon
PTSD
Symptoms: Increased startle, hypervigilance, sleep disturbances, concentration issues, anger outbursts.
> 2 days
Acute Stress Disorder
PTSD/Acute Stress Disorder
Tx: First-line: Paroxetine & sertraline
Relaxation
Psychotherapy to get coping techniques
Excessive anxiety or worry lasting greater than 6 months. Anxiety out for proportion to event.
symptoms: fatigue, concentration difficulty, sleep problems, muscle tension, restlessness.
Usually women
Tx: SSRI (Fluoxetine, paroxetine, sertraline, citalopram)
Venlafaxine and busiprone
Psychotherapy and behavioral therapy—not first line
Diazepam, lorazepam, clonazepam, alprazolam, oxazepam, chlordiazepoxide, temazepam, flurazepam
Benozodiazepines
SE: sedation, confusion, memory deficits, respiratory depression, addiction potential
Busiprone SE
SE: Headaches, nausea, dizziness
Lorazepam
given IM in emergencies
Clonazepam
longer half live- give if addiction is a concern
Chlordiazepoxide, oxazepam-
used frequently in treatment of alcohol withdrawal
Flurazepam, temazepam, triazolam
approved for hypotics
Flumazenil is a
benzodiazepine antagonist
Flumazenil indications
the overdose is acute & you are certain that there is no chronic dependence
Flumazenil SE
seizures in benzodiazepine-dependent patients.
causes acute withdrawal: tremor or seizures similar to delirium tremens
talkative, sullen, disinhibited, moody, gregarious
Alcohol Intoxication
Tx: mechanical ventilation if severe
tremors hallucinations, seizures, delirium tremens,
Alcohol withdrawal
Tx: benzodiazepine, thiamine, multivitamins, folic acid
Euphoria, hypervigilance, autonomic hyperactivity, weight loss, papillary dilation, perceptual disturbances
Cocaine/Amphetamine Intoxication
Tx: Antipsychotics and/or benzodiazepine and/or antihypertensives
anxiety, tremulousness, headache, increased appetite, depression, risk of suicide
Cocaine/Amphetamine Withdrawal
Tx: Bupropion and/or bromocriptine
Intoxication: Ideas of reference, perceptual disturbances, impaired judgment, tremors, incoordination, dissociative symptoms
Hallucinogen Intoxication
Antipsychotics and/or benzodiazepines and/ or talking down.
belligerence, apathy, aggression, impaired judgement, stupor, coma
Inhalant Intoxication
Tx: Antipsychotics
apathy, dysphoria, papillary constriction, drowsiness, slurred speech, coma, death
Opiates Intoxication
Naloxone
Fever, chills, lacrimation, abdominal cramps, muscle spasms, diarrhea
Opiates Withdrawal
Tx: clonodine, methadone, buprenorphine
belligerence, psychomotor agitation, violence, nystagmus, HTN, seizures
PCP Intoxication
Tx: antipsychotics and/or benzodiazepines and/or talking down
young, irritability, aggression, mania, psychosis
Anabolic steroid intoxication
Tx: antipsychotics
depression, headaches, anxiety, increased concern over body’s physical state
Anabolic Steroid withdrawal
Tx: SSRI
Somatoform disorder
Tx: Psychotherapy
Young women, unaware of psychological problems
Symptoms: 4 pain, 2 GI, 1 sexual, 1 pseudoneurological symptoms
Hypochondriasis:
Patients believe that they have some specific disease despite constant reassurance.
Conversion Disorder
voluntary motor or sensory functions, indicative of a medical condition
Unconcerned about impairment in the associated La Bell Indifferance
Body Dysmorphic Disorder
Patients believe that some part of the body is abnormal, defective, or misshapen
Pain Disorder
Pesence of pain, psychological factors associated with pain.
Facitious disorder
(Munchausen)
Tx: no specific therapy
Individual fakes an illness to get attention &emotional support in pt role
Either psychological or physical illness
Hx of being employed by healthcare
Rule out medical disorder Peptide c- levels. Call child protective services.
Malingering
Tx: Confront the pt
Conscious production of signs and symptoms for an OBVIOUS gain
Not a mental disorder
Patient: Prisoners and military personnel
Typically diagnosed when there is a discrepancy between the complaints and the physical/lab findings
Adjustment disorder
Tx: psychotherapy, individual and group
Characterized by maladaptive reaction to an identifiable stressor.
Loss of job, divorce or failure in school. If seeing murder or POW that would be PTSD
Usually occur w/in 3 mos of stressor &must remit w/in 6 months of removal of stressor.
Symptoms: Anxiety, depression, disturbances of conduct
Severe enough to cause impairment in functioning.
Suspicious, mistrustful, secretive, isolated and questioning the loyalty of family and friends
Paranoid
Loners, choice of solitary activities, lack close friends, emotional coldness, no desire for or enjoyment of close relationships. Content alone
Schizoid
Ideas of reference, magical thinking, odd thinking, eccentric behavior, increased social anxiety, brief psychotic episodes. Dragon statues, magic 8 ball in the room, dolls are magical and can talk
Schixotypal
Must be center of attention, inappropriate sexual behavior, self-dramatization
Use physical appearance to draw attention to self
Histrionic
Failure to conform to social rules, deceitful, lack of remorse, impulsive,
aggression towards others, Irresponsible, must be 18 years older
Antisocial
Conduct disorder usually leads to this
Unstable relationships, impulsive, recurrent suicidal behaviors, chronic feelings of emptiness,
inappropriate anger, dissociative symptoms when severely stressed, brief psychotic episodes
Borderline
Grandiose sense of self, belief that they are special, lack of empathy, sense of entitlement,
Require excessive admiration
Narcissistic
Unwilling to get involved with people, views self as socially inept, reluctant to take risks
Feelings of inadequacy. Want friends but unwilling to make risks.
Avoidant
Difficulty making day to day decisions, unable to assume responsibility, unable to express disagreement, fear of being alone, seeks relationships as source of care.
Dependent
Preoccupied with details, rigid, orderly, perfectionists, excessively devoted to work, inflexible
Obsessive Compulsive
Anorexia Nervosa
Tx:
Electrolytes
SSRI
High Bicarb, carotene, LFTs, amylase, cholesterol, cortisol
Low K, Cl, LH/FSH, estrogen
Re-feeding syndrome
Low PO4, Mg, Ca, and fluid retention
Bulimia Nervosa
SSRI
Don’t give bupropion
Narcolepsy
Sleep paralysis: awake but unable to move
Cataplexy: sudden loss of muscle tone, occurs with loud noises and sounds
Lack of REM sleep
Tx: modafinil, naps
Insomnia
Tx: Sleep hygiene, avoid naps, zolpidem, eszopiclone, zaleplon
