PSYCHIATRY Flashcards
What group of medications should be avoided in patients with bipolar disorder?
Selective serotonin reuptake inhibitors - increase the frequency of manic episodes
What is the diagnostic criteria for PTSD?
- History of exposure to a traumatic event of threatened death, injury or sexual violence AND 2.
At least 1 event of EACH of the following:
- intrusive recollection
- hyperarousal (hypervigilance in looking for signs of impending traumatic event)
- avoidance of stimuli associated with the trauma
- negative alterations in trauma associated cognitions and mood
Which SSRI is associated with the highest incidence of withdrawal if stopped abruptly? -least withdrawal?
Most withdrawal: paroxetine -least withdrawal: fluoxetine
What are helpful tips for talking to kids about separation from parents (from divorce, physical distance, etc.)?
-
What happened/seperation:
a. Explain to the child why the separation has happened.
b. Be concrete about what is happening.
2. Living situation/”home’:
a. Try to keep the child in their own home (ie. bringing someone in to help take care of them)
b. 4. If they have to move back and forth from mom’s to dad’s, allow them to bring transition object so that it’s a piece of their home.
c. Allow them to see the other parent.
d. Do NOT live together just for the kids because it’s very confusing for the child and builds false hope.
How do the following groups view death? -preschoolers -school age children -how can you explain death to child?
- Preschoolers: do not view death as permanent, often think it’s their fault
Explanation: -need to reassure them that it’s nothing that they did
2. School age children: usually have good understanding but only teenagers will have full understanding of permanence of death
Explanation:
a. do NOT compare it to sleep or else they’ll be terrified of sleeping
b. explain that death represents cessation of all body functions and that the person will not be returning
c. do not hide the event
d. do not give false or misleading info
What are 3 indications for use of risperidone?
- Schizophrenia
- Bipolar disorder
- Irritability in autism
- Tic disorder (2nd line)
How do antipsychotics work?
Block dopamine receptors
Which syndrome is associated with childhood psychosis?
Digeorge syndrome
What are common comorbid conditions are associated with ADHD? (5)
- Anxiety disorders
- Depression
- ODD
- Mood disorders
- Learning disability
What are the criteria needed for diagnosis of substance abuse?
Substance abuse:
- Recurrent failure to meet responsibilities
- Recurrent use in situations when such use is likely to be physically dangerous
- Recurrent legal problems arising from drug use
- Continued use despite knowledge of problems caused by or aggravated by use
What are the criteria needed for diagnosis of substance tolerance?
Substance dependence:
- Tolerance (needing more to become intoxicated or discovering less effect with same amount)
- Withdrawal
- Using more or for longer periods than intended
- Desire to cut down
- Considerable time spent in obtaining the substance
- Important Social/work/recreational activities given up because of use
Lithium toxicity What makes patients at risk for tocixity?
Whar are the Sx of lithium toxicity?
Risk factors:
Lithium has a narrow therapeutic window and can lead to toxicity in cases of significant water loss from the body due to diarrhea or vomiting, or due to interaction with other drugs.
Signs of lithium toxicity include
CNS: lack of coordination, slurred speech, blurred vision, and seizures, drowsiness, muscle weakness, tremor
GIT: Nausea, vomiting, diarrhea, stomach pain
DMDD Disruptive Mood Dysregulation Disorder What are the criteria for Dx? 5
Chronic, unremitting irritability and temper outbursts and that inconsistent with age/developmental stage
- Occurring at least 3 times a week
- Persistent irritable mood in between temper episodes
- Symptoms must be present > 1 yr and WITHOUT any period lasting for more than 3 consecutive months when patient DID NOT have these symptoms
- Symptoms must be present in at least 2 settings (in comparison to ODD, which can be diagnosed even if symptoms are present in only one setting)
- DX NOT BE MADE < 6 YRS OR > 18 YRS OF AGE
DMDD can coexist with what conditions?
- MDD
- ADHD
- CD
- Substance use disorders
DMDD CANNOT coexist with what conditions?
ODD, Intermittent explosive disorder, or bipolar disorder
- Individuals whose symptoms meet criteria for both DMDD and ODD should ONLY be given the diagnosis of DMDD
- If an individual has ever experienced a manic or hypomanic episode, the diagnosis of DMDD should NOT BE assigned
DMDD What is the Rx?
- Nonpharmacologic intervention:
Parent management training & CBT
2. Pharmacologic intervention:
a. Clear treatment guidelines have yet to be established
b. follow treatment for comorbid conditions (e.g., stimulant for ADHD, CBT, and SSRI for MDD)
c. Treatment approach DIFFERS from that for pediatric bipolar disorder, which is treated by mood stabilizers and antipsychotics
Schitzophrenia Dx What is the DSM criteria for Dx?
The presence of = or > 2 of the following, each present for a significant portion of time during a 1-month period with at least 1 of them being (1), (2), or (3):
(1) delusions,
(2) hallucinations,
(3) disorganized speech,
(4) disorganized or catatonic behavior, and
(5) negative symptoms
Additional:
a. For a significant portion of the time since the onset of the disturbance, level of functioning in 1 or more major areas (eg, work, interpersonal relations, or self-care) is markedly below the level achieved before onset; when the onset is in childhood or adolescence, the expected level of interpersonal, academic or occupational functioning is not achieved
b. Continuous signs of the disturbance persist for a period of at least 6 months, which must include at least 1 month of symptoms (or less if successfully treated); prodromal symptoms often precede the active phase, and residual symptoms may follow it, characterized by mild or subthreshold forms of hallucinations or delusions
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been RULED out because either (1) no major depressive, manic, or mixed episodes have occurred concurrently with the active-phase symptoms or (2) any mood episodes that have occurred during active-phase symptoms have been present for a minority of the total duration of the active and residual periods of the illness
d. The disturbance is not attributable to the physiologic effects of a substance (eg, a drug of abuse or a medication) or another medical condition
e. If there is a history of autism spectrum disorder or a communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations, in addition to the other required symptoms or schizophrenia are also present for at least 1 month (or less if successfully treated)
In addition to the 5 symptom domain areas identified in the first diagnostic criterion, assessment of cognition, depression, and mania symptom domains is vital for distinguishing between schizophrenia and other psychotic disorders.
What are the DDx for delerium?
