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Clinical review > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Unipolar disorder (major depression) or Major depressive disorder

A

Eti: genetic, anatomic, physiologic, chronic inflam, social stress
S/sx: SIGECAPS (sleep, interest lost, guilt, decreased energy, decreased concentration/cognition, change in appetite, psychomotor retardation, Suicide thoughts
DX: 5 or more of sigecaps for a least 2 weeks (must include depressed mood or pervasive anhedonia
Dx workup: CBC, TSH, folate/B12, consider RPR

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2
Q

Minor depression
persistent depressive disorder
(dysthymia)

A

A chronic depressive disturbance with sxs gen milder than MDD
S/sx: mild depressive sxs w/ no high phases; last longer than MDD
DSM 5: rule of 2, depressed mood for more days than not for greater than 2 years, never without symptoms for more than 2 months

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3
Q

Bipolar 1 and 2 eti and s/sx

A

Eti: 80-85% genetic. Usually begins in teens or early 20s
S/sx: Mania: 1 wk or greater DIG FAST (distractability, irritabiliity/impulsivity, grandiosity, flight of ideas, activity increase, decreased need for sleep, talkativeness)

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4
Q

DSM 5 criteria for Bipolar 1 and 2

A

Bipolar 1: manic episodes with or without depression

Bipolar 2: both depressive and hypomanic episodes without frank mania

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5
Q

Tx for bipolar

A

Mania: anti-psychotics w/ benzos; mood stabilizers with lithium, valproate (depekote)
Depression: lamotrigime/lithium. NO SSRI or SNRI
- Sleep hygiene

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6
Q

Adjustment disorder

A

Eti: depressive sxs following a major identifiable life stressor (divorce, job loss etc.)
DSM 5 Crit: sx onset within 3 months of stressor and must resolve within 6 months after termination of stressor.
Tx: Behavioral, social, psychotherapy, pharm

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7
Q

GAD: generalized anxiety disorder

A

Eti: age 20-35, rate increases with age
S/sx: apprehension, worry , irritability, difficulty in concentrating, insomnia.
Tx: SSRIs, SNRIs, benzos for acute

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8
Q

Phobic disorder

A

Marked fear or anxiety about a specific object or situation.
S/sx: Fears of a specific object or situation out of proportion with the danger
Tx: CBT, pharm

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9
Q

Panic disorder

A

Eti: tends to be familial, onset under 25. Female more than male
S/sx: Characterized by short lived, recurrent, unpredictable episodes of intense anxiety accompanied by physiologic manifestations
Tx: reassurance and education. Meds: SSRIs and SNRIs, benzo for initial treatment

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10
Q

Obsessive compulsive disorder

A

Pt. recognizes the obsession and compulsions are absurd but have anxiety if they are not completed.
S/sx: Experience regular, intrusive, anxiety provoking thoughts and driven to repeated actions
Tx: CBT, SSRIs, TCA (clomiparmine)

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11
Q

PTSD

A

Symptoms usually begin within first 3 months after trauma. Characterized by re-experiencing the traumatic event
S/sx: Symptoms need to be present for at least 1 month
Tx: psychotherapy, pharm

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12
Q

Body dysmorphic disorder

A

Eti: Involves the unreasonable sense that something about the body is malformed or inadequate.
S/sx: may spend excessive time looking at our seeking treatment for a condition. Preoccupied with condition spend much time thinking about condition.
Tx; Increased risk of SI, SSRI (off label). CBT

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13
Q

Tricyclic antidepressants (TCAs)

A

amitriptyline, nortriptyline, clomipramine, trimipramine, doxepin..
MOA: inhibit reuptake of NorEpi and Serotonin (SNRI effects but older)
Indic: Depression, fibromyalgia, neuro pain, migraine prophylaxis
CI: coadmin with MAOIs, or recovery from MI
AE: anticholinergic, sedation, SI, hallucinations, arrhythmias
Monitoring: narrow therapeutic window
Pt ed: don’t stop suddenly

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14
Q

SSRIs

A

citalopram, escitalopram, fluoxetine, paroxetine, sertraline
MOA: SSRIs
AE: Black box: SI, nausea, anxiety, drowsiness, wt gain, sex dysfunction
CI: MAOI use, linezolid use, methylene blue
Pt ed: don’t stop suddenly, avoid ETOH, time to start working 2-12 weeks

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15
Q

Fluoxetine

A

SSRI: Prozac: long half life (can be taken weekly)
Indic: Depression, bulimia, OCD, PMDD, panic disorder
Monitoring: Mental status, SI, baseline liver function, EKG with risk of QT
AE: CYP 450 inhibition, lots of drug interactions
Dose: 20-80 mg/d

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16
Q

Paroxetine

A

SSRI: Paxil
Indic: depression, anxiety, OCD, PTSD,PMDD, Vasomotor sx (menopause)
Lots of drug interactions, CYP 450 inhibitor
dose: 20-50

17
Q

sertraline

A

SSRI: Zoloft
Indic: depression, OCD, panic, PTSD, PMDD, social anxiety disorder
Monitor: mental status for depression, SI, height/wt peds
dose: 50-200

18
Q

citalopram

A 
SSRI: Celexa
Indic: Depression, OCD
Monitor: SI, electrolyetes at base line, ECG if long QT suspected
Fewer drug interactions
dose: 20-60 mg/d
19
Q

escitalopram

A

SSRI: Lexapro
Indication: depression, anxiety
Monitor: SI, ECG if long QT suspected
dose: 10-20 mg/d

20
Q

Lithium

A

MOA: interferes w/PIP2 recycling, leading to depletion in neuronal membrane in CNS
Indic: Mood stabilizer for mania and hypomania in bipolar disorder
CI: severe CV or renal disease, dehydration, sodium depletion, hypothyroid
AE: LMNOP see next card
Interactions: careful with other drugs that increase serotonin (TCAs, SSRIs, MAOIs) can be bad for heart
dose: 900-1800 mg/d in 3 or 4 divided doses
Pt. ed: stay hydrated

21
Q

AE for lithium

A 
LMNOP: 
leukocytosis
movement disorders
nephrogenic DI
hypothyroid
pregnancy (CI)
22
Q

MAOIs

A

monoamine oxidase inhibitors
phenelzine, tranylcypromine, isocarboxazid, selegiline (also used for Parkinson’s)
MOA: inactivate enzyme monoamine oxidase which breaks down excess NT. (Inhibits MAO in the brain, liver and gut thus many AEs)
Interactions: many food and drug. No with SSRIs or buproprion
Monitor: blood glucose, renal and liver function

23
Q

Valproic acid

A

Depakote
MOA: increases GABA
Indic: complex partial seizures, absence seizure, mania, bipolar, migraine prophylaxis,
CI: liver disease, preggo
AE: hepatotoxicity, HA, dizziness, N/V/D, tremor
Interaction: many
Monitor: LFTs first 6 months

24
Q

Lamotrigine

A 
Lamictal
MOA: inhibits release of glutamate (excitatory amino acid), inhibits Na channel to stabilize neuronal membranes
Indic: bipolar 1, epilepsy
AE: SJS/TEN
Interactions: many
25
Q

carbamazepine

A

Tegretol
MOA: Blocks Nachannels, inhibiting generation of repetitive action potentials in epileptic focus and preventing spread.
Indic: AntiConvulsant, anticholinergic, antineuralgic, antidiuretic, muscle relaxant, antimanic, antidepressive, antiarrhythmic
CI: TCAs, bone marrow suppresion
AE: TEN/SJS, arrhythmia, AV block

26
Q

venlafaxine, desvenlafaxine

A

Effexor, Pristiq
MOA: (SNRI) inhibits S and N at high dosages, and mildly inhibits dopamine reuptake
Indic: depression who fail SSRIs, anxiety, , cataplexy, panic, migraines, neuro pain
CI: Use within 14 days of MAOIs, linezolid, methylene blue
Interaction: warfarin, lithium, tramadol, antipsychs, antiDs

27
Q

duloxetine

A

Cymbalta
MOA: SNRI at all doses
Indic: Depression, anxiety, fibromyalgia, neuro pain, chronic MSK pain
CI: hepatic insufficiency, CKD, MAOIs, linezolid, methylene blue.

28
Q

bupropion

A

Atypical antiD
Wellbutrin
MOA: weak: dopaminergic, noradrenergic. short half life.
Indic: Depression, smoking cessation, SAD, parkinsons.
CI: seizure disorder, bulimia
AE: black box: SI. Seizure, hallucination, TachyC, wt. loss, NO SEXUAL DYSFUNCTION
Interactions: few, MAOIs

29
Q

Mirtazapine

A

Atypical antiD
MOA: enhances serotonin and norepi NT by serving as an antagonist at alpha2 and 5-HT receptors.
Indic: depression, OCD, PTSD
AE: anticholenergic, long QT, lowers seizure threshold, CNS depression, drowsiness, wt gain
Interactions: drugs that cause long QT, anticholinergics, serotonergic effects
Monitor: suicidality

30
Q

Trazodone

A

Atypical antiD
MOA: weak SSRI, anti-histamine H1 blocker
Indication: depression, insomnia (off label)
CI: Preg cat C, linezolid, methylene blue
AE: anticholinergic, long QT, lowers seizure threshold, CNS depression
Interactions: careful for serotonin syndrome or with drugs that cause long QT.

31
Q

Serotonin syndrome: Eti?

A

Eti: taking 2 or more serotonergic drugs at the same time.
Drugs: SSRIs, SNRIs, MAOIs, TCAs, opiates, non rx cough meds, anti emetics, anti migraine drugs, drugs of abuse (cocaine) , muscle relaxers.

32
Q

Serotonin syndrome: clinical presentation

A

Abrupt onset within 24 hours of med change
Sx: confusion, agitation, muscle rigidity, myoclonus, shivering, diaphoresis, fever, fever, diarrhea, seizures, HTN
Complications: DIC, neutropenia, thrombocytopenia, seizure, multi organ failure, rhabdo, AKF, acidosis
Tx: d/c SSRI, benzo 1st line for agitation etc.

33
Q

Serotonin discontinuation syndrome

A 
Eti: abrupt d/c of antiD that has been taken for at least 6 weeks
S/sx: FINISH
Flu like symptoms
Insomnia
Nausea
Imbalance
Sensory disturbance
Hyperarousal
Tx: slow taper of drug

Clinical review (18 decks)

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