Psychiatry Flashcards
Infant deprivation effects
S - Social engagement disinhibited - indiscriminately attaches
T - Trust (lack of)
A - Attachment disorder (reactive) - withdrawn/unresponsive
T - Thrive (failure)
S - Socialization skills are poor
Child neglect
Failure to provide a child with: S - shelter S - supervision A - affection F - food E - education
Attention-deficit
hyperactivity
disorder
Onset before age 12, > 6 months of limited attention span and/or poor impulse control.
in multiple settings
Normal intelligence, but commonly coexists with difficulties in school. Often persists into adulthood.
Treatment: stimulants (eg, methylphenidate) +/- cognitive-behavioral therapy (CBT);
alternatives include:
C - clonidine
A - atomoxetine
G - guanfacine
Autism spectrum
disorder
May be accompanied by intellectual disability;
rarely accompanied by unusual abilities (savants).
More common in boys.
Associated with inc head/brain size.
Disruptive mood
dysregulation
disorder
Onset before age 10. Severe, recurrent temper outbursts out of proportion to the situation.
The child is constantly angry and irritable between outbursts.
Treatment: stimulants, antipsychotics.
Intellectual disability
Global cognitive deficits (vs specific learning disorder)
Adaptive functioning is impaired
Treatment: comprehensive, multidisciplinary support to improve global functioning (eg, special education, psychotherapy, speech therapy, occupational therapy).
Selective mutism
Onset before age 5. Anxiety disorder lasting > I month involving refraining from speech in certain
situations despite speaking in other, usually more comfortable situations
Commonly comorbid with a social anxiety disorder. Treatment: behavioral, family, and play therapy; SSRIs.
“5elective, 4 weeks (month)”
Separation anxiety
disorder
An overwhelming fear of separation from home or attachment figure lasting > 4 weeks.
Can be normal behavior up to age 3- 4.
May lead to factitious physical complaints to avoid school.
Treatment: CBT, play therapy, family therapy.
Specific learning
disorder
Onset during school-age years.
Inability to acquire or use information from a specific subject (eg, math, read ing, writing) near age-expected proficiency for > 6 months despite focused intervention.
Treatment: academic support, counseling, extracurricular activities.
Tourette syndrome
Onset before age 18.
Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor and vocal tics that persist for> I year. Coprolalia (involuntary obscene speech) found in only 40%. of patients.
Treatment: psychoeducation, behavioral therapy.
T - Typical high-potency antipsychotics (eg, haloperidol, fluphenazine)
A - alfa 2 -agonists (eg, guanfacine, clonidine)
T - tetrabenazine
A - atypical antipsychotics.
Orientation - Order of loss:
Order of loss: time -> place -> person.
Delusions Types:
Erotomanic, Grandiose
J - jealous U - unspecified M - mixed P - persecutory S - somatic
Schizophrenia - Symptom categories include:
Positive-hallucinations, delusions, unusual thought processes, disorganized speech, bizarre behavior.
Negative- Aat or blunted affect, apathy, anhedonia, alogia, social withdrawal
Cognitive- reduced ability to understand or make plans, diminished working memory, inattention
Schizophrenia diagnosis requires:
Diagnosis requires > 2 of the following active symptoms, including > 1 from symptoms #1- 3:
- Delusions
- Hallucinations, often auditory
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Requires > I month of active symptoms over the past 6 months;
onset > 6 months prior to diagnosis.
Brief psychotic disorder vs Schizophreniform
Brief psychotic disorder: > I positive symptom(s) lasting < I month, usually stress-related.
Schizophreniform disorder: > 2 symptoms lasting 1-6 months.
Schizophrenia - pathology, and pathophysiology
Associated with:
Inc dopaminergic activity
Inc serotonergic activity
Dec dendritic branching.
Ventriculomegaly on brain imaging.
Schizoaffective disorder
Shares symptoms with both schizophrenia and mood disorders (major depressive or bipolar disorder). To differentiate from a mood disorder with psychotic features, the patient must have> 2 weeks of psychotic symptoms without a manic or depressive episode.
Delusional disorder
> 1 delusion(s) lasting > 1 month, but without a mood disorder or other psychotic symptoms.
Daily functioning, including socialization, may be impacted by the pathological, fixed belief but is otherwise
unaffected. It can be shared by individuals in close relationships (folie a Deux).
Manic episode
activity or energy lasting > I week.
Diagnosis requires hospitalization or marked functional impairment with > 3 of the following
(manics DIG FAST):
D - Distractibility
I - impulsivity/Indiscretion
G - Grandiosity
F - Flight of ideas
A - Agitation
S - Sleep (dec need)
T - Talkativeness
Hypomanic episode
Similar to a manic episode except mood disturbance is not severe enough to cause marked impairment in social and/or occupational functioning or to necessitate hospitalization. No psychotic features. Lasts >4 consecutive days.
0.5 manic
Bipolar disorder - Bipolar I
> I manic episode +/- a hypomanic or depressive episode (may be separated by any length of time).
1-1.5 manic
The patient’s mood and functioning usually normalize between episodes.
The use of antidepressants can destabilize mood.
High suicide risk.
Treatment: mood stabilizers (eg, lithium, valproic acid, carbamazepine, lamotrigine), atypical antipsychotics.
Bipolar disorder - Bipolar II
a hypomanic and a depressive episode (no history of manic episodes).
0.5 + depression
The patient’s mood and functioning usually normalize between episodes. The use of antidepressants can
destabilize mood. High suicide risk. Treatment: mood stabilizers (eg, lithium, valproic acid, carbamazepine, lamotrigine), atypical antipsychotics.
Cyclothymic disorder
a milder form of bipolar disorder fluctuating between mild depressive and hypomanic symptoms. Must last > 2 years with symptoms present at least half of the time, with any remission lasting < 2 months.
0.5 + 0.5 deperssion
Major depressive disorder - Dx
> 5 of the 9 diagnostic symptoms lasting > 2 weeks - must include patient-reported depressed mood OR anhedonia. Screen for history of manic or hypomanic episodes to rule out bipolar disorder.
SIG E CAPS
S - Sleep disturbance
I - Interest loss
G - Guilt
E - energy dec
C - Concentration
A - Apetite/weight change
P - Psychomotor retardation
S - Suicide
Major depressive disorder - Tx
Treatment: CBT and SSRIs are the first line.
SNRIs, mirtazapine, bupropion can also be considered.
Electroconvulsive therapy (ECT) in treatment-resistant patients.
MDD with psychotic features
MDD accompanied by hallucinations or delusions.
Psychotic features are typically mood-congruent (depressive themes of inadequacy, guilt, punishment, nihilism, disease, or death).
Psychotic features occur only in the context of the major depressive episode (vs schizoaffective disorder).
Treatment: antidepressant with atypical antipsychotics, ECT.
Persistent depressive disorder (dysthymia)
often milder, > 2 depressive symptoms lasting >2 years, with no more than 2 months without depressive symptoms.
DI(2)thymia = >2 sx, >2 y, <2 m w/o
Peripartum mood disturbances - Maternal (postpartum) blues
%/Dx/Tx
Maternal (postpartum) blues -50- 85%, 2-3 days after delivery. Usually resolves within 10 days.
Treatment: supportive
Peripartum mood disturbances - MDD with peripartum
%/Dx/Tx
MOD with peripartum - 10-15%, Characterized by depressed affect, anxiety, and poor concentration for > 2 weeks. Treatment: CBT and SSRIs are first line.
Peripartum mood disturbances - Postpartum psychosis
%/Dx/Tx
Postpartum psychosis - 0.1% - mood-congruent delusions, hallucinations, and thoughts of harming the baby or self.
Risk factors include a history of bipolar or psychotic disorder, first pregnancy, family history, recent discontinuation of psychotropic medication.
Treatment: hospitalization and initiation of atypical antipsychotic; if insufficient, ECT may be used.
Grief Duration
Duration varies widely; usually resolves within 6- 12 months.
Complicated grief is persistent and causes functional impairment. Can meet criteria for major depressive episode.
Electroconvulsive
therapy used for:
Rapid-acting method to treat:
- . resistant or refractory depression
- depression with psychotic symptoms
- catatonia
- acute suicidality.
No absolute contraindications - Safe in pregnant and elderly individuals.
Risk factors for suicide completion
S - Spouse or other social support gone
A - Attempt in past (highest risk factor)
D - Depression
M - Male
A - Age (young adult or elderly)
D - Drug/EtOH
P - Psychosis
I - Intent (stated)
P - Plan
S - Sickness (medical)
Panic disorder
Diagnosis requires attack followed by > I month of >I of the following:
• Persistent concern of additional attacks
• Worrying about the consequences of an attack
• Behavioral change related to attacks
S - SOB T - Trembling U - Unsteadiness D - Depersonalization E - Excessive HR N - Numbness T - Tingling S - Sweating
P - Palpitations A - Abdomen distress N - Nausea I - Intense fear for losing control/dying C - Chest pain
Social anxiety disorder-
Exaggerated fear of embarrassment in social situations (eg, public speaking, using public restrooms).
Treatment: CBT- with exposure therapy, SSRIs, venlafaxine.
For performance type (eg, anxiety restricted to public speaking), use beta-blockers or benzodiazepines as needed.
Severe, persistent (> 6 months) fear or anxiety due to presence or anticipation of a specific object or
situation. The person often recognizes fear is excessive
Agoraphobia
Irrational fear/anxiety while facing or anticipating > 2 specific situations (eg, open/ closed spaces, lines, crowds, public transport).
If severe, patients may refuse to leave their homes. Associated with panic disorder.
Treatment: CBT - with exposure therapy, SSRIs.
Severe, persistent (> 6 months) fear or anxiety due to presence or anticipation of a specific object or
situation. The person often recognizes fear is excessive
Obsessive-compulsive
disorders
Obsessions (recurring intrusive thoughts, feelings, or sensations) that cause severe distress, relieved
in part by compulsions (performance of repetitive ac tions). Ego-dystonic.
Treatment: CBT and SSRIs; clomipramine and venlafaxine are second Iine.
Body dysmorphic disorder
Preoccupation with minor or imagined defects in appearance.
Causes significant emotional distress and repetitive appearance-related behaviors (eg, mirror checking, excessive grooming). Common in eating disorders. Treatment: CBT.
Trichotillomania Tx:
psychotherapy is first-line; medications (eg, clomipramine) may be considered.
Generalized anxiety disorder
Excessive anxiety and worry about different aspects of daily life (eg, work, school, children) for most days of > 6 months. Associated with > 3of the following for adults (> 1 for kids):
C - concentrating difficulty o n F - fatigue I - irritability R - restlessness M - muscle tension S - sleep disturbance
Treatment: CBT, SSRIs, SNRIs are first line. Buspirone, TCAs, benzodiazepines are the second line.
Adjustment disorder
Emotional symptoms (eg, anxiety, depression) that occur within 3 months of an identifiable psychosocial stressor (eg, divorce, illness) lasting< 6 months once the stressor has ended. If symptoms persist > 6 months after the stressor ends, it is GAD.
Post-traumatic stress
disorder
Disturbance lasts > 1 month with significant distress or impaired functioning. Treatment: CBT, SSRIs, and venlafaxine are the first line. Prazosin can reduce nightmares.
H - Hyperarousal
A - Avoidance of associated stimuli
R - Re-experiencing
D - Distress
Acute stress disorder
lasts between 3 days and I month. Treatment: CBT; pharmacotherapy is usually not indicated.
Refeeding syndrome-
often occurs in significantly malnourished patients with sudden inc calorie intake. Food intake -> inc insulin -> hypophosphatemia, hypokalemia, hypomagnesemia -> cardiac complications, rhabdomyolysis, seizures.
Bulimia nervosa - Associated with
Vomiting:
parotid gland hypertrophy (may see inc serum amylase)
enamel erosion,
electrolyte disturbances (eg, hypokalemia, hypochloremia)
metabolic alkalosis
dorsal hand calluses from induced vomiting (Russell sign).
lisdexamfetamine.
Binge-eating disorder Tx (2nd line)
psychotherapy (first line); SSRIs
Sleep terror disorder
Periods of inconsolable terror with screaming in the middle of the night.
Most common in children.
This occurs during slow-wave/deep (stage N3) non-REM sleep with no memory of the arousal episode, as opposed to nightmares that occur during REM sleep (remembering a scary dream). Triggers include emotional stress, fever, and lack of sleep.
Usually self-limited.
Narcolepsy
Excessive daytime sleepiness (despite awakening well-rested) with recurrent episodes of rapid-onset,
overwhelming sleepiness >3 times/week for the last 3 months.
Due to dec orexin (hypocretin) production in lateral hypothalamus and dysregulated sleep-wake cycles.
Associated with:
C - Cataplexy (loss of all muscle tone after stimulus)
H - hallucinations (Hypnagogic/hypnopompic)
i
P - paralysis of sleep (start with REM sleep)
Treatment: good sleep hygiene (scheduled naps, regular sleep schedule), daytime stimulants (eg, amphetamines, modafinil) and/or nighttime sodium oxybate (GHB).
Enuresis
Urinary incontinence > 2 times/week for> 3 months in person > 5 years old.
First-line treatment:
behavioral modification (eg, scheduled voids, nighttime fluid restriction) and positive reinforcement.
For refractory cases: bedwetting alarm, oral desmopressin (ADH analog; preferred over imipramine due to fewer side effects).
Substance use
disorder
A maladaptive pattern of substance use involving> 2 of the following in the past year:
Losing control: cravings, Using more, inability to cut down, Time consuming.
Social: Social or interpersonal conflicts, dec functioning at work/school/home, dec. recreational activities
Risk: Use despite awareness of the harm, > I episode of use involving danger
Health: Tolerance, Withdrawal
Serotonin syndrome
Nonpsychiatric drugs:
M - MDMA O - ondansetron L - linezolid D - dextromethorphan S - St. John's wort
M - meperidine
a
T - tramadol
T - triptans
Serotonin syndrome Psychiatric drugs:
MAO inhibitors, SSRIs, SNRIs, TCAs, vilazodone, vortioxetine
lithium toxicity - medications affecting clearance
T - thiazide
A - ACEi
N - NSAIDs
Amphetamines vs Cocaine
Both present with pupillary dilation and cardiac issues.
Amphetamines - skin excoriations.
Cocaine - nasal septum perforations.
Central nervous system stimulants
Methylphenidate, dextroamphetamine, methamphetamine, lisdexamfetamine.
B - binge-eating disorder
A - ADHD
N - narcolepsy
Vilazodone vs Vortioxetine
Both Inhibits 5-HT reuptake, Used for MDD, nausea, anticholinergic effects.
Vilazodone - 5-HT1A receptor partial agonist
Vortioxetine - 5-HT1A receptor agonist and 5-HT3 receptor antagonist (Vor-3-oxetine), toxicity: sexual dysfunction, sleep disturbances.
Schizophrenia - epidemiology
Lifetime prevalence- 1.5% (males >females).
Presents earlier in men (late teens to early 20s) than in women (late 20s to early 30s).
Inc suicide risk.
Schizophrenia - Tx
Treatment: atypical antipsychotics (eg, risperidone) are the first line.
Negative symptoms often persist after treatment, despite the resolution of positive symptoms.
