Psychiatry Flashcards
_____ (Bipolar I/II) is characterized by one or more manice or mixed episodes, usually accompanied by major depressive episodes.
Bipolar I
_____ (Bipolar I/II) is characterized by one ore more major depressive episodes accompanied by at least on HYPOmanic episode.
Bipolar II
Treatment of acute mania involves:
- Antipsychotics in conjunction with benzos
- Initiation of a mood stabilizer like lithium
1st line for acute psychosis includes:
Oral atypicals- Risperidone, clozapine, olanzapine, Haldol
Mood stabilizers- Lithium, Valproic Acid
Psychosis is the prominent feature in 4 clinical d/o that are frequently encountered in the ED:
- Schizophrenia
- Schizophreniform
- Delusional D/o
- Brief Psychotic D/o
For a diagnosis of schizophrenia the patient can exhibit both positive and negative symptoms for A MINIMUM OF ___ MONTHS.
6
Positive v. Negative symptoms of Schizophrenia…
- Positive- hallucinations, delusions, disorganized speech, catatonia
- Negative- blunted affect, lack of spontaneity, anhedonia, emotional withdrawal, impaired cognitive ability
For treatment of BOTH positive and negative sx of Schizophrenia give Idone’s and Apine’s!!
-Risperidone, Clozapine, Quetiapine, etc.
_____ is identical to Schizophrenia but for less than 6 months. Usually it is a brief psychotic d/o lasting less than 4 weeks in response to
Schizophreniform
_____ disorder is characterized by persistent, non-bizarre delusions that do not cause impairment of social functioning
Delusional
- Typically onset occurs in mid-to-late adulthood, with women > men
- *Persecutory delusions, delusions of infidelity on the part of a significant other, or delusions of being ill or having body odor are common
***Treatment- Supportive, though psychotherapy may play a role
Psychosis that lasts from 14 days- 1 month and is typically associated with a stressful life event is known as _____.
Brief psychotic disorder
*Antipsychotics may be required but the disease is usually self-limited
RFs for depression include:
Hx of depression in family, alcohol, substance abuse, female gender, prior depression
Episodes of major depression typically last from 6-12 months. What are some medication options?
- SSRI- fluoxetine, paroxetine, sertraline
- TCAs- amitriptyline, despramine, etc.
- MAOIs- phenelzine
- Mixed group- venlafaxine, bupropion, trazodone, etc.
A diagnosis of ____ is characterized by excessive anxiety and worry (apprehension expectation), occurring more days than not for at least 6 months, about a number of events or activities
GAD
Anxiety and worry (with regard to GAD) are associated with 3 or more of the following:
- Restlessness or feeling keyed up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Sleep disturbance
The peak age of onset of panic disorder is mid-20s. Signs and symptoms include:
•Recurrent, unexpected panic attacks that begin suddenly, peak in intensity within 10 min, and include a sensation of intense fear along with at least 4 of the following:
- Palpitations or increased heart rate, sweating, trembling, shaking, shortness of breath, or a feeling of choking
- Chest pain or discomfort; nausea or abdominal distress; dizziness or lightheadedness
- Derealization or depersonalization
- Fear of losing control or going crazy; fear of dying
- Paresthesias, chills, hot flashes
For a dx of panic disorder at least 1 attack must be followed for 1 month or more by 1 of the following:
- Persistent worry about additional attacks (anticipatory anxiety)
- Worry about the implications of the attack
- A change in baseline function secondary to the attack
Treatment of panic disorder involves:
Psychotherapy (CBT) with SSRIs
- TCAs and MAOIs are 2nd line choices
- In the ED–> Benzos may be used for immediate relief, but long-term use of these drugs should be avoided in some patients in light of their addiction potential
Symptoms of PTSD must be present for > 1 month and are classified according to their duration:
- Acute = symptoms present for <3 months
- Chronic = symptoms present for >3 months
- Delayed onset = symptoms start >6 months after the traumatic event.
Treatment of PTSD involves-
SSRIs and mood stabilizers are 1st line
- Anxiolytics such as benzos and alpha-agonists may be used
- CBT and support groups
Withdrawal from alcohol begins in _____ hours after last drink. Lasts 4-7 days.
12-24 hours
Inpatient management needed for alcohol withdrawal if there is a history of:
seizures, delirium, mental instability, suicidal or homicidal ideation, psychosis, unstable environment, or no support or transportation available
What is given to help manage alcohol withdrawal?
- Thiamine, folate, and B6 supplementation
- Supplement Mg
- IV benzos q 10-15 mins PRN
- Phenobarbital or propofol for refractory DTs
False + on opiod drug screen if you’ve ingested:
-Rifampin, quinolone, or poppy seeds
Managing withdrawals from different drugs:
- Benzos/barbiturates- ABCs, activated charcoal
- Cocaine- self-limited, detox not required (acute OD managed with benzos and severe agitation managed with haldol)
- Opiates- treat with naloxone, buprenorphine, or clonidine
Some suicide facts…
Women more likely to attempt, men more likely to complete.
Men more likely to commit suicide by violent means such as firearm use; women more likely to commit suicide by drug ingestion
RFs for suicide include:
S- sex (male) A- age D- depression P- previous attempt E- ethanol R- rational thought S- sickness O- organized pain N- no spouse S- social support lacking
Depressed individuals are often at greatest risk for suicide in the first few weeks after starting an antidepressant because:
Their energy may return before the depressed mood lifts
