Psychiatry Flashcards
What is Schizoaffective Disorders?
Symptoms of schizophrenia and a mood disorder
What is Schizophrenia?
positive and negative psychotic symptoms lasting for >6m
What is Schizophreniform Disorder?
symptoms of schizophrena lasting between 1-6months
What are positive symptoms of schizophrenia?
delusions, disorganized speech, hallucinations
what are negative symptoms of schizophrenia?
flattened affect, social withdrawal, anhedonia, apathy, poverty of thought
What is a brief psychotic disorder?
psychotic symptoms present for <1m
What is Delusional Disorder?
person suffers from delusions but minimal to no hallucinations or bizarre behaviour. there is no impairment of baseline functioning.
You suspect a psychotic disorder or some sort. What tests do you need to order/run before you go jumping to dx something psyc?
TSH(hypo/hyperthyroidism), Electrolytes, Ca, HIV serology, VDRL, Drug screen, r/o temporal lobe epilepsy
How do you treat a psychotic break? when do you start long term psyc meds?
- hospitalize if needed
- benzos for agitation & antipsychotics for 6 months
*start long term therapy if there are repeat episodes
Besides treating psychotic disorders what 2 other indications are there for anti-psychotic medications?
- sedation
2. movement disorders(huntingtons, disease and tourettes syndrome)
Side effect profile for Thioridazine
prolonged QT and arrhythmias, abnormal retinal pigmentation
What is Tardive Dyskinesia? tx?
choreoathetosis that occurs over months to years of use with use of antipsychotics(D antag).
Tx: denztropine or Valbenazine
What is Acute Dystonia? timing treatment?
TIMING: first few weeks
SX: muscle spasms, difficulty swallowing
TX: reduce the dose, give anticholinergics(benztropine, diphenhydramine, trihexyphenidyl)
What is Bradykinesia? timing? treatment?
TIMING: weeks
SX: bradykinesia, tremors, rigidity and other signs of parkinsons
TX: reduce the dose, anticholinergics(benztropine, diphenhydramine, trihexyphenidyl)
What is Akathisia? timing? treatment?
TIMING: weeks - chonic use
SX: motor restlessness. *DO NOT MISTAKE FOR ANXIETY
TX: reduce the dose, Benzodiazepines or BB, switch to newer antipsychotic
What is Tardive Dyskinesia? timing? treatment?
TIMING: months - years
SX: choreoathetosis and other involuntary movements after chronic use, often irreversible
TX: Stop older antipsyc, switch to newer drugs, give valbenazine or benztropine *sx often worsen after medication change
What is Neuroleptic Malignant Syndrome? timing? treatment?
TIMING: anytime
SX: muscle rigidity, hyperthermia, volatile vital signs, altered LOC, increased WBC, increased CK
TX: stop drugs, transfer to ICU, dantrolene.
You suspect the patient may have an anxiety disorder. What are some other causes of anxiety you should consider before dx.
Medical: hyperthyroidism, pheochromocytoma, excess cortisol, heart failure, arrhythmias, asthma, COPD
Drugs: corticosteroids, cocaine, amphetamines, and caffeine, withdrawal from alcohol and sedatives.
What is Adjustment Disorder?
anxiety, depression, irritability that occurs soon after profound changes in a persons life. Occurs within 3 months of a stressful event.
What is Panic Disorder? Tx?
brief attacks of intense anxiety with autonomic symptoms( tachycardia, hyperventilation, dizziness and sweating), episodes occur regularly.
TX: CBT, relaxation, desensitization, SSRIs and Benzos
What is Agoraphobia?
fear of avoidance of places due to anxiety about NOT BEING ABLE TO ESCAPE.
What is Social Anxiety Disorder?
Avoidance of objects of situations other than those involved in agoraphobia.
What is Generalized Anxiety Disorder(GAD)? Tx?
Excess anxiety that occurs daily for more than 6 months. no single focus or event. often coexists with other shit(MDD, specific phobia, social phobia, panic disorder).
tx: CBT, SSRI, Benzo, vanlafaxine, buspirone
Order the benzos from shortest to longest half life: lorazepam, diazepam & alprazolam
shortest: Alprazolam(xanax) < Lorazepam(Ativan) < Diazepam(Valium) :longest
What is Obsessive-Compulsive Disorder(OCD)? Tx?
recurrent obsessions and compulsions. Individual recognizes behavior is unreasonable and excess. Often coexist with depression and substance abuse.
**DO NOT HAVE HALLUCINATIONS
Tx: behavioral therapy, SSRI and Clomipramine.
Acute Stress Disorder vs Posttraumatic Stress Disorder(PTSD) duration?
ASD: occurs within 1 month and lasts <1 month of event
PTSD: >1 month
You suspect pt has MDD? what are other causes of depression you should check for before making the dx?
Hypothyroidism, Parkinsons Disease, Medications( BB, antipsyc, steroids), Alcohol, amphetamines
Symptoms of Major Depressive Disorder(MDD)?
SIGECAPS: Sleep changes Interest loss Guilt Energy decrease Concentration difficulty Appetite changes Psychomotor activity changes Suicidal thoughts
What is Persistent Depressive Disorder(Dysthymia)? tx?
Low level depression symptoms that are present on most days for at least 2 years
tx: long term individual, insight oriented psychotherapy. SSRIs
What is Seasonal Affective Disorder? tx?
depressive symptoms in the winter months
tx: phototherapy or sleep deprivation
Bipolar 1 VS Bipolar 2 VS Cyclothymia
Bipolar 1: Mania
Bipolar 2: hypomania + depression
Cyclothymia: hypomania + hypodepression
Treatment for bipolar disorder?
1st line: Lithium, Lamotrigine or Risperidone
2nd line: aripiprazole, divalproex, quetiapine, olanzapine
+ CBT and psychotherapy
Postpartum Blues/Baby Blues VS Postpartum Depression VS Postpartum Psychosis
Postpartum Blues/Baby Blues = cares about baby, mild depression, self limited
Postpartum Depression = +/- thoughts of hurting baby, severe depression, needs antidepressants
Postpartum Psychosis = most have thoughts of hurting baby, psychotic symptoms along with severe depression, needs antidepressants and mood stabilizers.
Indications for Elecctroconvulsive Therapy(ECT)
- MDD nonresponsive to medications
- high risk for immediate suicide
- C/I to using antidepressants
- good response to ECT in the past
How long is a patient with MDD on antidepressants?
6 months then try to take them off. only need long term with multiple episodes
which SSRI can you NOT use in prego?
paroxetine
What is Illness Anxiety Disorder(IAD)?
pt experiences anxiety about having a illness for at least 6 months
What is Conversion Disorder?
one or more NEUROLOGIC symptoms that cannot be explained by any medical or neurological disorder.
- usually mutism, blindness, paralysis and anethesia/paresthesia.
- *pt are usually not concerned about the deficit
Factitious Disorder VS Malingering Disorder
Factitious = wants to be patient Malingering = wants \$\$$
Compare: Anorexia Nervosa, Bulimia Neurvosa, Binge Eating Disorder, Body Dysmorphic Disorder
Anorexia: underweight, food restriction or excessive exercise, history of of purging or compensation
Bulimia: normal weight, binge eating + guilt and some sort of compensation(vomiting, diuretics or enema use)
Binge Eating Disorder: recurrent episodes of eating large quantities, feelings of lost of control during binge. Do not regularly have compensatory behaviors.
Body Dysmorphic Disorder: pt is preoccupied with an imagined or slight defects in appearance with impaired ability to function in social or occupational settings.
What is Kelptomania?
pt who repeatedly steals items to relieve anxiety
What is Disruptive Mood Dysregulation Disorder?
child with a pervasively angry or irritable mood, with frequent outburst that are out of proportion to the stresses. PATIENTS DO NOT RETURN TO A NORMAL MOODS after outburst. They are just pissy.
What is Intermittent Explosive Disorder? tx?
Episodes of aggression out of proportion to the stressor +/- history of head trauma. Only dx in AGE 6+. with episodes 2x a week for 3 months or destructive episodes 3x within a 12 month period.
tx: SSRI & mood stablizers
Personality Disorders: Cluster A?
Cluster A = Weird
*paranoid PD, Schoid PD, Schiotypal PD
Personality Disorders: Cluster B?
Cluster B = Wild
*histrionic PD, Boarderline PD, Antisocial PD, Narcissistic PD
Personality Disorders: Cluster C?
Cluster C = Worried
*Avoidant PD, Dependent PD, Obsessive-Compulsive PD
What is Obsessive-Compulsive PD?
individuals are preoccupied with orderliness, perfections and control. They are often consumed by the details of everything and lose their sense of overall goals.
What is Dependent PD?
submissive and clinging behavior related to a need to be taken care of. clingy and worry about abandonment. they feel inadequate and helpless and avoid disagreements with others. they usually focus on dependency on a family member or spouse.
What is Avoidant PD?
individuals have social inhibition, feelings of inadequacy and hypersensitivity to criticism. They shy away from starting anything new or attending social gatherings in fear of failure or rejection. they desire affection and acceptance and are open about their isolated and inability to interact with others.
What is Narcissistic PD?
Characterized by a sense of self-importance, grandiosity, preoccupation with fantasies of success. Person believes he is special, requires excessive admiration, reacts wit rage when criticized, lacks empathy, is envious of others, and is interpersonal exploitative.
What is Antisocial PD?
antisocial or criminal acts, inability to conform to social rules, impulsivity, disregard for the rights of others, aggressiveness, lack of remorse and deceitfulness
What is Borderline PD?
unstable affect, mood swings, marked impulsivity, unstable relationships, recurrent suicidal behaviors, chronic feelings of emptiness, identity disturbances, and inappropriate anger.
*defense mechanism is usually splitting
What is Histrionic PD?
colorful, exaggerated behavior and excitable, shallow expression of emotions. use of physical appearance to draw attention to self. sexually seductive, discomfort in situations where not the center of attention.
What is Schizotypal PD?
Discomfort with socal relationships, thought distortion, eccentricity. similar to schizoid but with magical thinking, clairvoyance, ideas of reference, or paranoid ideation.
What is Schizoid PD?
detachment and restricted emotionally. Emotionally distant and fear intimacy with others, absorbed in their own thoughts and feelings and disinterested
What is Paranoid PD?
distrust suspiciousness, individuals are mistrustful and suspicious of the motivations and actions of others are are often secretive and isolated. they are emotionally cold and odd. they often take legal action against other ppl.
*main defense is projection.
What is the mechanism of action of Disulfiram?
Disulfiram inhibits the enzyme acetaldehyde dehydrogenase leading to an increase in acetaldehyde when alcohol is consumed. Acetaldehyde causes NV, HA, tachycardia and sweating
Stages/Timeline of Alcohol withdrawal
6 hrs: Minor Withdrawal = insomia, tremulousness, HA, palpitations, diaphoresis
*give thiamine, folate, vitammin, glucose
12-24hrs: Alcoholic hallucinosis = visual hallucinations
48 hr: Withdrawal Seizures
48-86hr: Delirium Tremens = hallucinations, diorientations, tachycardia, HTN, low-grade fever, agitation and Diaphoresis.
Delirium Tremens
sx?
occurs 48-96hrs after last drink(2 days)
Delirium Tremens = hallucinations, diorientations, tachycardia, HTN, low-grade fever, agitation and Diaphoresis.
What is Voyeurism?
Recurrent urges to observe an unsuspecting person who is engaging in sexual activity or disrobing. This is the earliest paraphilia to develop.
What is Exhibitionism?
recurrent urge to expose oneself to strangers
What is Frotteurism?
Recurrent urge or behavior involving touching or rubbing against a non-consenting partner
