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Emergency Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

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1
Q

_____ (Bipolar I/II) is characterized by one or more manice or mixed episodes, usually accompanied by major depressive episodes.

A

Bipolar I

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2
Q

_____ (Bipolar I/II) is characterized by one ore more major depressive episodes accompanied by at least on HYPOmanic episode.

A

Bipolar II

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3
Q

Treatment of acute mania involves:

A
  • Antipsychotics in conjunction with benzos

- Initiation of a mood stabilizer like lithium

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4
Q

1st line for acute psychosis includes:

A

Oral atypicals- Risperidone, clozapine, olanzapine, Haldol

Mood stabilizers- Lithium, Valproic Acid

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5
Q

Psychosis is the prominent feature in 4 clinical d/o that are frequently encountered in the ED:

A
  1. Schizophrenia
  2. Schizophreniform
  3. Delusional D/o
  4. Brief Psychotic D/o
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6
Q

For a diagnosis of schizophrenia the patient can exhibit both positive and negative symptoms for A MINIMUM OF ___ MONTHS.

A

6

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7
Q

Positive v. Negative symptoms of Schizophrenia…

A
  1. Positive- hallucinations, delusions, disorganized speech, catatonia
  2. Negative- blunted affect, lack of spontaneity, anhedonia, emotional withdrawal, impaired cognitive ability
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8
Q

For treatment of BOTH positive and negative sx of Schizophrenia give Idone’s and Apine’s!!

A

-Risperidone, Clozapine, Quetiapine, etc.

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9
Q

_____ 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

A

Schizophreniform

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10
Q

_____ disorder is characterized by persistent, non-bizarre delusions that do not cause impairment of social functioning

A

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

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11
Q

Psychosis that lasts from 14 days- 1 month and is typically associated with a stressful life event is known as _____.

A

Brief psychotic disorder

*Antipsychotics may be required but the disease is usually self-limited

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12
Q

RFs for depression include:

A

Hx of depression in family, alcohol, substance abuse, female gender, prior depression

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13
Q

Episodes of major depression typically last from 6-12 months. What are some medication options?

A
  1. SSRI- fluoxetine, paroxetine, sertraline
  2. TCAs- amitriptyline, despramine, etc.
  3. MAOIs- phenelzine
  4. Mixed group- venlafaxine, bupropion, trazodone, etc.
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14
Q

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

A

GAD

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15
Q

Anxiety and worry (with regard to GAD) are associated with 3 or more of the following:

A
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance
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16
Q

The peak age of onset of panic disorder is mid-20s. Signs and symptoms include:

A

•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:

  1. Palpitations or increased heart rate, sweating, trembling, shaking, shortness of breath, or a feeling of choking
  2. Chest pain or discomfort; nausea or abdominal distress; dizziness or lightheadedness
  3. Derealization or depersonalization
  4. Fear of losing control or going crazy; fear of dying
  5. Paresthesias, chills, hot flashes
17
Q

For a dx of panic disorder at least 1 attack must be followed for 1 month or more by 1 of the following:

A
  • Persistent worry about additional attacks (anticipatory anxiety)
  • Worry about the implications of the attack
  • A change in baseline function secondary to the attack
18
Q

Treatment of panic disorder involves:

A

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
19
Q

Symptoms of PTSD must be present for > 1 month and are classified according to their duration:

A
  • Acute = symptoms present for <3 months
  • Chronic = symptoms present for >3 months
  • Delayed onset = symptoms start >6 months after the traumatic event.
20
Q

Treatment of PTSD involves-

A

SSRIs and mood stabilizers are 1st line

  • Anxiolytics such as benzos and alpha-agonists may be used
  • CBT and support groups
21
Q

Withdrawal from alcohol begins in _____ hours after last drink. Lasts 4-7 days.

A

12-24 hours

22
Q

Inpatient management needed for alcohol withdrawal if there is a history of:

A

seizures, delirium, mental instability, suicidal or homicidal ideation, psychosis, unstable environment, or no support or transportation available

23
Q

What is given to help manage alcohol withdrawal?

A
  • Thiamine, folate, and B6 supplementation
  • Supplement Mg
  • IV benzos q 10-15 mins PRN
  • Phenobarbital or propofol for refractory DTs
24
Q

False + on opiod drug screen if you’ve ingested:

A

-Rifampin, quinolone, or poppy seeds

25
Q

Managing withdrawals from different drugs:

A
  1. Benzos/barbiturates- ABCs, activated charcoal
  2. Cocaine- self-limited, detox not required (acute OD managed with benzos and severe agitation managed with haldol)
  3. Opiates- treat with naloxone, buprenorphine, or clonidine
26
Q

Some suicide facts…

A

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

27
Q

RFs for suicide include:

A 
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
28
Q

Depressed individuals are often at greatest risk for suicide in the first few weeks after starting an antidepressant because:

A

Their energy may return before the depressed mood lifts

Emergency Medicine (11 decks)

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