Psychiatry Flashcards
Weight neutral 2nd gen antipsychotic drugs
Aripiprazole and ziprasidone
Side effect of 2nd gen antipsychotic drugs?
Metabolic syndromes
Increase BP/glucose/weight/cholesterol
Symptoms of NMS?
Fever/confusion/”lead pipe” rigidity/increased CPK/leukocytosis/increase HR/RR/BP
Name this drug!
Side effect—>retinal pigmentation
Side effect—>deposits in lens and cornea
Thioridazine
Chlorpromazine
Tx plan for schizophreniform disorder
6 month of antipsychotic
Schizoaffective disorder critieria
at least 2 weeks of delusion and hallucination without mood disorder (distinguish from mood disorder with psychotic features)
Criteria for delusional disorder
Delusion for a year/function well over 1 month
Erotomanic (sb in love with ya)/grandeur/persecution/somatic/jealous/mixed
Could have hallucination
Koro/Amok/Brain fag?
Koro—>anxious that penis would recede into the body
Amok—>burst of violence with suicide
Brain fag—>somatic disturbance among African males
Criteria for major depressive disorder
Pt with what medical condition tend to develop it?
How does it affect sleep stages?
5 out of SIG E CAP for over 2 weeks
Stroke
Increase duration of REM and decrease stage 3 and 4
What is a psychiatric emergency? and what is its criteria?what about hypomania
Maniac episode/ symptoms over 7 days
Over at least 4 days
Tx for atypical depression (mood reactivity)?
SSRI (not MAOi)
Criteria for Bipolar I and II
Bipolar I (highest genetic linkage)--->manic episodes with or without depression Bipolar II--->major depression and hypomania
Li+ side effect?
LMNOP Li+ Movement (tremor) Nephrogenic DI HypOthyroidism Pregnancy
Tx for rapid cycling bipolar
Carbamazapine or volproic acid
Prego with manic episode, tx?
ECT
Criteria of persistent depressive disorder (dysthymia)? MDD is episodic
Over 2 years and never asymptomatic over 2 months
Criteria for cyclothymic disorder and tx
Alternate between symptoms of hypomania and depression (not full hypomania and depression otherwise it would be bipolar II) over 2 years
Tend to become bipolar
Tx—>Li+
Tx for premenstral dysphoric disorder
SSRI/OCP can reduce symptoms
Criteria for disruptive mod dysregulation disorder
severe verbal and physical outbursts >3 times a week for 1 year before age of 10
At least 2 settings
Tx for anxiety disorder
Psychotherapy for mild (CBT)
Drugs combo for severe
Use benzo to bridge till SSRI start working
Risk factor for panic attacks?
Smoking
Timeline for criteria of agoraphobia or phobia
over 6 months
Criteria for selective mutism/tx?
Failure to speak in social settings for at least 1 month (related to anxiety)
Tx—>SSRI/CBT
when does stranger and separation anxiety start? and when does it become pathologic
Tx?
6 month, peaks at 9 month 1 year, peaks at 1 year and half Separation anxiety disorder---->reluctant to leave home/sleep alone At least for 1 month in children Tx--->CBT/SSRI
GAD criteria? tx?
Excessive worrying over 6 month
Fatigue/impaired attention/restlessness
Tx—>CBT/SSRI
Ketamine usage and MOA?
NMDA antagonist
Start and maintain anesthesia
Side effect of risperidone that is different from the rest of the atypical?
Increase prolactin—>amenorrhea/infertility/sexual dysfunction
Criteria for panic disorder
Increase or decrease risk for suicide?
Tx?
Recurrent panic attacks Fear of future panic attacks--->change behaviors Lead to agoraphobia Increase risk for suicide CBT and SSRI
pathophysiology of OCD and tx
Intrusive obsession that pt tries to suppress using compulsions (repetitive behaviors)—>causing anxiety
CBT (exposure response)/SSRI/ECT (last resort)
Pt underwent multiple plastic surgeries/repetitive grooming/comparing looks with others, diagnosis and tx?
Body dysmorphic disorder/SSRI and CBT
What precedes hoarding disorder and what tx?
Stressful and traumatic event
CBT
Tx for trichotillomania and excoriation disorder?
SSRI/2nd antipsychotic/N-acetylcysteine/Li+
CBT (habit reversal training)
Criteria for PTSD and acute stress disorder? tx? what med is used for nightmares?
Nightmares/flashbacks/avoidance/increase arousal
Acute stress disorder—> >1 month
SSRI/CBT (cognitive processing therapy)
Prazosin (alpha 1 antagonist)
What comorbid disorder occur with PTSD?
Substance abuse disorder so don’t use addictive meds for PTSD pts
Criteria for adjustment disorder? tx?
Stressful event happens within 3 month and resolve by 6 months
Supportive psychotherapy
Difference between PTSD and adjustment disorder?
Event happened in PTSD is life threatening, and not so in adjustment disorder
What are the 3 clusters of personality disorder? tx?
Cluster A—>eccentric/like psychotic disorders
Cluster B—>emotional/dramatic/like mood disorders
Cluster C—>anxious/fearful/like anxiety disorder
Use psychotherapy since most of pt are not aware
Cluster A
Paranoid—>jealous (think others are cheating on them)/everybody is against them
Schizoid—>happy to be alone, forever and ever/cold
Schizotypal—>odd and magical/social anxiety
Cluster B
Antisocial—>adult version (18yr) of conduct disorder/no remorse/manipulative (charming)
Borderline personality disorder—>impulsivity/extreme love-hate relationship/recurrent suicide attempts
Histrionic—>theatrical and attention seeking/seductive/easily influenced
Narcissistic—>superiority/need for admiration/lack empathy/arrogant—>depressed if recognition are not gained
What kind of defense mechanism does pt with boarderline personality disorder/histrionic/dependent personality disorder use?
boarderline—>Splitting
Histrionic and dependent—>Regression
Cluster C
Avoidant personality disorder—>social anxiety/fear of rejection, unliked/want relationships/very shy
Dependent—>poor self confidence/helpless when left alone/always in relationships/submissive/clinging
Obsessive compulsive—>perfectionism/inflexible/no delegation/frugal/rigid
Avoidant personality disorder looks like which other disorder?
Social anxiety disorder
Difference between OCD and OCPD?
OCD is ego-dystonic—>pts are aware
OCPD is ego-syntonic—>pts are not aware
EtOH can cause what kind of medical condition?
Metabolic acidosis
Withdraw symptoms of EtOH?
Irritability—>seizure—>DT (2 to 3 days)
Tx for alcohol use disorder
Naltrexone—>decrease craving
Acamprosate—>for relapse prevention after detox/contraindicate in pt with renal disease
Disulfiram—>block aldehyde dehydrogenase
Topiramate—>decrease craving
Symptoms of DT
disorientation/agitation/hallucination/increase RR, HR and BP
Cocaine MOA and complication
Block reuptake of DA/NE/Epi
MI/stroke/hemorrhage
Methamphetamine MOA and complication
Block reuptake of DA and NE
Induce psychosis/tooth decay
What is MDMA? and does it show up on tox screen?
Amphetamine and no
What kind of drug is heroin?
Opioid
High and low potency typical antipsychotics
High (NMS/TD)—>trifluoperazine/fluphenazine/haloperidol
Low (antihistamine/antiM/anti alpha1)—>chlorpromazine/thioridazine
What drug class are prochlorperazine and metoclopramide?
Prochlorperazine—>typical antipsychotic
Metoclopramide—>D2 antagnonist
Rotatory nystamus and what is its MOA
PCP intoxication
Anti NMDA
tx for barb intoxication and barb withdraw mimics?
Alkalinize urine with NaCO3
Alcohol
MAOi and what opioid taken together can cause serotonin syndrome?
Meperidine
Opioid withdraw symptoms?
insomnia/nasal discharge/yawning/sweating/dilated pupils
Tx for prego with opioid-dependence?
Mathadone
What is in suboxone
Buprenorphine (partial agonist) and naloxone
Difference between naloxone and naltrexone
Naloxone—>for emergency opioid intox
Naltrexone—>long acting, for long term dependence
What drug is used to treat the autonomic symptoms of opioid withdraw
Clonidine
What is dronabinol?
FDA approved THC
what are the 4 mood stabilizers and their side effects
Li+—>LMOP
valproic acid—>weight gain/hepatitis
carbamazapine—>aplastic anemia
lamotrigine—>steven johnson
Which TCA has the fewest antiM side effect?
Nortriptyline
Effect of mirtazapine
Antidepressant—>cause weight gain and sedating
How long should bereavement be abated?
Within 6 months
Criteria for intellectual disability
Deficits in intellectual/adaptive functioning
Require ongoing support of daily life
Global developmental delay
Failure to meet expected developmental milestones
need future reevaluation
Criteria for ADHD
Inattention and hyperactivity/impulsivity (2 types)
> 6 months and in 2 or more settings
Diagnosed
Comorbid disorders with ADHD?
Oppositional defiant/conduct/learning disorder
ADHD tx
First line —>methylphenidate or other stimulants
Second line —>atomoxetine (NE reuptake inhibitor)
alpha 2 agonist —>clonidine (sedating)/guanfacine
What should be checked and be aware before starting Li+/valproic acid/carbamazapine
Li+—>check for kidney and thyroid function and Na+ level /dont change diet or use salt wasting diuretics
Valproic acid—>check liver function
Carbamazapine—>aplastic anemia
Which opioid has the highest affinity for mu receptor?
Buprenorphine
And when is opioid withdraw fetal
during pregnancy for the fetus
What is the symptoms of acute Li+ toxicity?
Confusion/mimic CVA
What to do with a manic pt who’s on max dose of Li+?
Add a 2nd gen antipsychotic