Psychiatry Flashcards
1
Q
HY symptoms of depression
A
anhedonia
weight changes
sleep changes
poor concentration
2
Q
first line agent in depression
A
SSRI ALONE (without any other antidepressants)
3
Q
2 exceptions to SSRI use in depression
A
- depression + NEUROPATHIC PAIN
- depression +….
- fearful of weight gain
- sexual SE’s
- smoker trying to quit
4
Q
tx depression + NEUROPATHIC PAIN
A
DULOXETINE
5
Q
tx depression +….
- fearful of weight gain
- sexual SE’s
- smoker trying to quit
A
BUPROPION
6
Q
choice of SSRI + antidepressant in depression
A
WRONGGGGGGG!!!!!
choose the cleanest= SSRI on its own
7
Q
tx mild depression + sleep problems
A
MIRTAZAPINE,
since= antidepressant + sedative
8
Q
what to exclude with presentation of mania
A
COCAINE and AMPHETAMINE use….
thus hx and toxicology
9
Q
first line tx acute mania
A
LITHIUM
10
Q
PC: 33yo man, brought to emergency room, bipolar, recently started on lithium, combative and punches nurse on the mouth. what’s the next best mgmt
A
ADEQUATE TX> admission to psychiatric unit;
ANTIPSYCHOTICS= first line tx
11
Q
tx acute mania with severe symptoms
A
atypical antipsychotics
12
Q
tx dysthymia
A
antidepressant meds + psychotherapy
13
Q
tx atypical depression
A
MAOIs = usually the correct answer
14
Q
seasonal affective disorder
A
phototherapy– 12-18 inches from source of 10,000 lux of white fluorescent light without UV wavelengths for 30 minutes each morning; eyes open, but don’t necessarily stare at the light
15
Q
tx of normal bereavement
A
PSYHCOTHERAPY
never never never pharmacology
16
Q
exception to strict diagnosis of major depressive disorder (5/9 for >6months, for 2 weeks)
A
if the symptoms are SEVERE ENOUGH
17
Q
emergency situation of psychosis tx
A
IM atypical antipsychotic> haloperidol
18
Q
tx of schizophrenia with psychotic episode, that is unresponsive to typical ro atypical antipsychotics
A
CLOZAPINE
19
Q
avoid olanzapine in…
A
diabetics
obese patients
20
Q
big SE of risperidone
A
MOVEMENT disorders
21
Q
benefit of quetiapine
A
lower incised of movement disorders; thus ok to use in pots with movement disorders
22
Q
avoid ziprasidone in patients with…
A
conduction defects since prolongs QT interval
23
Q
clozapine monitor
A
CBC, since high risk of agranulocytosis
NEVER THE FIRST LINE TREATMENT
24
Q
ariprazole use
A
ADJUNCT+ for major depressive disorer
25
only antipsychotic that can be used in pregnancy
lurasidone
26
LEAST likely drug to cause weight gain and diabetes in schizophrenia
1. ARIPRAZOLE
| 2. ZIPRASIDONE
27
timing of movement side effects with antipsychotics...
| HOURS--DAYS
ACUTE dystonia
28
tx of acute dystonia
benztropine
trihexyphenidyl
diphenhydramine
29
timing of movement side effects with antipsychotics...
| WEEKS
AKATHASIA
30
tx of akathasia
DECREASE dose
beta blockers
switch to atypical antipsychotics
benzodiazepine
31
timing of movement side effects with antipsychotics...
| GREATER THAN 6 MONTHS
tardive dyskinesia
32
tx of tardive dyskineasia
switch to atypical antipsychotics
33
LOWEST RISK OF tadive dyskinesia
CLOZAPINE
34
PC delusional disorder
```
NON-bizarre delusions
NO impairment of functioning
- still obeys law
- goes to work
- pays bills
```
>1 month
35
tx of manic disorder-- PSYCHOTIC FEATURES and AGITATION
ANTIpsychotics> lithium;
| because RAPID action
36
PC panic attack
patient is presenting with autonomic hyperactivity
37
Tx panic attack
benzodiazepines: lorazepam, clonazepam, aprazolam
38
PC pain disorder
patient is giving you STORY/HISTORY of these symptoms
| 4+ autonomic hyperactivity,
39
Tx panic disorder
SSRI's
40
tx of phobias
behavioural modification
| and relaxation techniques
41
tx of performance anxiety-- stage fright
BETA BLOCKERS; 30-60minutes before performance
42
tx of OCD
SSRIs
43
tx of OCD, when all the options are TCAs
CLOMIPRAMINE
44
tx of hoarding disorders
#1: SSR's
can also do behavioural mod or psychotherapy--CBT
45
what to exclude in diagnosis of PTSD
substance abuse--- since will worsen the diagnosis
46
first line treatment for PTSD
paroxetine and sertraline
47
other tx options for PTSD
relaxation techniques
48
tx of GAD
1st line: SSRs
2. venlafaxine
3. buspirone
49
panic disorder vs. GAD
panic disorder: 30 minutes of symptoms
| GAD: chronicity of symptoms >6months; constantly worried
50
lorazepam use
IM injection, thus EMERGENCY situations
51
clonazepam use
LONG HALF LIFE-- if worried about addiction--
| LOW addiction
52
chlordiazepoxide use
alcohol withdrawal
53
oxazepam use
alcohol withdrawal a/w LIVER problems
54
lorazepam non-emergency use
alcohol withdrawal a/w LIVER problems
55
alprazolam use
panic disorder and panic attack
56
flurazepam use
hypnotic (rarely used)
57
temazepam use
hypnotic (rarely used)
58
triazolam use
hypnotic (rarely used)
59
tx of somatic symptom disorders=
| somatoform disorders
PSYCHOTHERAPY
60
PC: patient inflicts life-threatening injury on themselves
in order to get attention... thus FACTITIOUS DISORDER
61
caretaker fakes signs and symptoms on another person (usually a child)
= factitious disorder IMPOSED on others
62
signs and symptoms fakes on oneself
= factitious disorder IMPOSED on self
63
how does a man with factitious disorder present
PHYSICAL symptoms
64
typical PC of factitious disorder
WOMAN
| hx of working in HEALTHCARE
65
dx of factitious disorder
MUST confirm by excluding legitimate medical illness
66
tx of factious disorder
NO TREATMENT proven to bed effective
| - with child--> child protective services
67
malingering
DOES NOT = MENTAL ILLNESS
PRISONERS/ MILITARY
typically when DISCREPANCY between patients complaints and physical/lab findings
DO NOT COOPERATE
68
tx of acute alcohol intoxication thats severe
mechanical ventilation
69
tx of alcohol withdrawal
long acting benzos
B1
folate
70
PC: drugs- constricted pupils
opiod intoxication
71
PC: drugs- dilated pupils, lacrimation, yawning
opiod withdrawal
72
mgmt opiod withdrawal
methadone
buprenorphine
clonidine
73
PC: drugs- seizures
bento's OR cocaine or PCP
74
PC: drugs- poor sleep and depression and anxious
withdrawal from benzo's
75
PC: drugs- dilated pupils and sweating, and hypertensive
amphetamines intoxication
76
PC: drugs- increase appetite and sedated
amphetamines withdrawal
77
tx of amphetamines and cocaine withdrawal
bupropion and bromocriptin
78
tx of amphetamines and cocaine intoxaication
benzo's
blood pressure mgmt-- ALPHA blockers
antipsychotics
79
withdrawal mgmt of nicotine
buproprion
| varenciline
80
PC: drugs- nystagmus and ataxia
PCP intoxication
81
PC: drugs- VIOLENT behaviour
PCP intoxication
82
tx of PCP intoxication
bento's and antisychotics (rapid)
83
PC: drugs- angry, tired, depressed
PCP withdrawal
84
PC: drugs- euphoria and hallucinations
LSD intoxication
85
any withdrawal from LSD or marijuana or inhalants
NOOOOPE
86
PC: drugs- conjunctival injection
marijuana
87
2 synthetic cannabis
1. K2
| 2. spice
88
PC: drugs- irritable, signs of psychosis, and mania
ANABOLIC STEROIDS
89
withdrawal from anabolic steroids
depression/anxious/headache/
| concern over physical appearance
90
PC: drugs- belligerent, apathetic, aggressive, STUPOR-->COMA
inhalants
91
tx of inhalant use
antipsychotics
92
similarities in anorexia and bulimia
purging
fasting
laxative and diuretic abuse
XS exercise
93
age of anorexia vs. bulimia
younger in anorexics
94
premorbid hx for bulimia
obesity before
95
mgmt of anorexia
1. hospitalization for dehydration/electro disturbances
2. psychotherapy
3. SSRI's
96
mgmt of bulimia-- need hospitalization
NOOOOOO
psychotherapy
SSRI's
97
tx of binge eating disorder
topiramate
| psychotherapy: CBT, DBT, interpersonal
98
eating disorder not other wise specified
anorexia criteria-- BUT PERIOD NORMAL
anorexia criteria-- BUT WEIGHT NORMAL
compensatory behaviour-- BUT NORMAL AMOUNTS FOOD
99
step 1 drug choice for anorexia
mirtazapine-- since cures depression, and makes them gain weight
100
tx of choice in narcolepsy
modafinil
| and forced naps during the day
101
specific features of narcolepsy
1. sleep attacks
2. cataplexy
3. hypnogogic and hypnopompic hallucinations
4. sleep paralysis
102
sleep attacks
episodes of IRRESISTIBLE sleepiness and feeling refreshed upon awakening
103
caaplexy
sudden loss of muscle tone
104
sleep paralysis
patient is AWAKE but unable to move-- typically occurs upon wakening
105
tx of sleep apnea
nasal CPAP
weight loss
corrective surgery
AVOID-- sedatives and alcohol which WORSEN condition
106
tx of insomnia
sleep hygiene techniques
| non-benzo's
107
sexual identity
based on persons secondary SEXUAL characteristics
108
gender identity
sense of maleness or femaleness-- established by 3yo
109
gender role
based on EXTERNAL patterns of behaviour that reflect inner sense of gender identity
110
sexual orientation
choice of love
111
nb thing about patient with SUICIDAL IDEATION
take them all seriously and HOSPITALIZE the patient
112
impotence tx
EXCLUDE medical or medication causes
psychotherapy
couples sexual therapy
113
premature ejaculation
1. psychotherapy
2. behavioural modification-- stop and go, squeeze
3. SSRI's
114
genitopelvic pain disorder
= dyspareunia,
| tx- psychotherapy
115
penetration disorder
= vagnismus-- involuntary constriction of outer third of vagina preventing penile insertion
116
paraphilic disorders
RECURRENT sexual arousing, mc in men, focusing on HUMILIATION, nonconsenting partners or use f non living objects, must occur for GREATER than 6 months and cause distress and poor level functioning
117
exhibitionism
recurrent urge to expose oneself to strangers
118
fetishism
recurrent use of non living objects to achieve sexual pleasure
119
masochism
recurrent urge or behaviour in HUMILIATING acts
120
sadism
recurrent urge or behaviour involving physical or psychological suffering of victim is exciting
121
transvestic fetishism
recurrent urge or behaviour in cross dressing
122
frotteurism
rubbing, usually ones pelvis or erect penis against a nonconsenting person for sexual gratification
123
tx of paraphilias
psychotherapy
behavioural modification
antiandrogens or SSRIs to decrease sexual drive
124
gender dysphoria
gender identity disorder-- persistent discomfort and sense of inappropriateness regarding patients assigned sex
125
mental retardation = intellectual disability
DEFECTIVE intellectural function AND SOCIAL adaptive functioning
126
tx for intellectual disability
GENETIC COUNSELING
127
autism spectrum disorders has replaced
autim, retts, aspergers
128
age of autism
3yo
129
timing with ADHD
GREATER than 6 months before the age of 7
130
2 areas dx of ADHD
HOME and SCHOOL
131
FIRST LINE TX ADHD-- STEP 2CK
atomoxetine (since side effects of other tx)
132
oppositional defiant
argue and lose temper
problems with AUTHORITY
DO NOT BREAK RULES
133
tx oppositional defiant
less oppositional behaviour and clinical mgmt. skills for parents
134
conduct disorder
less than 18yo,
| persistently break rules, bully, cruelty, crimes, vandalism
135
tx conduct disorder
behavioural intervention-- rewards for prosocial and nonaggressive behaviour
aggression--> antipsychotic
136
DMDD= disruptive mood dysregulation disorder AGE
boys 6-10yo, NOT BEFORE 6 or AFTER 10yo
137
more likely to develop with DMDD...
bipolar
depression
anxiety
138
DMDD symptoms
OUTBURSTS of anger
SADNESS in between,
occurring every day--noticeable to others, out of proportion; NEVER SYMPTOM FREE FOR >3MONTHS
139
tx DMDD
individual therapy
| may need meds for specific symptoms
