Psychiatry Flashcards
How do we best define generalized anxiety disorder and criteria?
Chronic, insidious low level anxiety all the time
Constant state of worry for at least 6 months and at least 3 somatic changes (sleep, weight, concentration)
Best treatment for GAD?
Treatment for a panic attack, not the disorder?
Psychotherapy much more effective than meds, but if you do get to meds, SSRIs.
Benzo
What to use for a panic attack acutely to abort it?
What to use for chronic panic disorder?
Benzo
SSRI +- CBT
Best treatment for phobias?
CBT - desensitization under benzo
What med to give for public speaking social phobia?
Non selective beta blocker
Best treatment for depression?
Next?
ECT
SSRI and therapy
When would you hospitalize a pt for suicide?
Idea and plan
First line treatment for mania/bi polar type 1?
Second?
Third?
Lithium
Valproic acid
Carbamazepine
Stages of sleep and what they show on EEG?
1,2,3 and REM
1: theta waves
2: K complexes
3: Delta waves
Rem: awake brain Rapid eye movements and Antonia
Define sleep latency?
REM latency?
Bed to stage 1
Stage 1 to REM
Increase serotonin has what affect on sleep?
Increase Ach has what affect on sleep?
NE and Dopamine has affect on sleep?
GABA has what affect on sleep?
Increase sleep
Increase dreaming
Increase arousal and awake
Decrease sleep latency
3 6s of depression treatment?
Try drug for 6 weeks
Treat for 6 months
Wash out for 6 weeks
Side effect for SSRIs to know?
Sexual dysfunction
What are the 3 c’s of TCAs?
Convulsions (seizures), cardio toxicity, and coma
What is another indication of TCAs besides antidepressants?
Neuropathic pain, especially diabetic neuropathy
When to only use selegiline or phenylzine?
Hypertensive crisis
2 first line mood disorder drugs?
2 second line mood disorder drugs?
Lithium and valproate
Quetiopine and lamotrigine
Positive psychotics symptoms are what receptor?
Negative psychotic symptoms are what receptor?
Dopamine 2 mesolimbic
Serotonin
Very potent first generation med usually used in hospital?
Haloperidol
Side effect for quetiapine second generation?
Side effect for clonzapine second generation?
Side effect for risperidone second generation?
Sleepiness, so treat insomnia
Weight gain and diabetes
EPS
What second generation is the best but why don’t we use it?
Clozapine
Agranulocytosis
What is the best, most effective contraception?
LARC
Non IUD
IUD, hormone or copper
Triad for DVT Risk involving contraception?
Estrogen, smoking and over 35
What contraception form has the highest risk for DVT?
Patches
What med to give for hot flashes of menopause?
Vaginal atrophy?
What to screen menopause women for, 2 things?
Venlafaxine
Estrogen cream
heart disease, so check LDL and put on statin
Osteoporosis, do dexa screen at 65, bisphosphonates, vitamin d and calcium
2 ways to diagnose PCOS with the history already there?
LH to FSH ratio
US the ovaries and see all the cysts
What med to give for PCOS to help her ovulate?
Clomiphene
How to treat CAH?
Give her cortisol and
What kind of bleeding has previa with it during 3rd trimester?
What about not previa diseases?
Painless, that is coming from the placenta that is baby’s blood
Painful that is coming from moms blood from uterus
When does placenta previa present?
How to treat?
3rd trimester with painless bleeding. Basically when contractions start and cervical dilates it tears placenta and baby’s blood comes out.
C section
In what 2 settings do we have uterine rupture?
Clinical identifier?
Treatment?
Attempting to deliver vaginally after previous c section
Oxytocin
Painful bleeding and loss of fetal station
Crash section, get it out
3 causes of placenta abruption?
HTN, cocaine use, MVA
How to diagnose diabetes in pregnancy?
Treatment?
Do a 1 hour glucose tolerance and if its over 140 do a 3 hour If 1 hour over 180 2 hour over 155 3 hour over 140 Fasting over 90 Insulin
When do you screen for pregnancy anemia?
How to diagnose?
Cause?
Treat?
28 weeks
HgB less than 10, hct less than 30
Iron deficiency
Give iron
