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Online Med Ed > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

generalized anxiety disorder path

A

constant state of worry

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2
Q

generalized anxiety disorder pt

A

worry about most things on most days of most months (>/= 6mo)
>/= 3 somatic complaints

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3
Q

generalized anxiety disorder dx

A

clinical

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4
Q

generalized anxiety disorder tx

A

psychotherapy

SSRI or buspirone adjunct

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5
Q

social anxiety disorder path

A

irrational and exaggerated fear related to social performance
egodystonic
6mo+ duration

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6
Q

social anxiety disorder pt

A

anxiety and avoidance of stimulus

public speaking or public restrooms

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7
Q

social anxiety disorder dx

A

clinical

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8
Q

social anxiety disorder tx

A

CBT

ß blockers for public speaking

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9
Q

specific phobia path

A

irrational and exaggerated learned fear response to a specific trigger
egodystonic
6mo+ duration

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10
Q

specific phobia pt

A

anxiety and avoidance of stimulus

spiders, heights, clowns, etc

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11
Q

specific phobia dx

A

clinical

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12
Q

specific phobia tx

A

CBT
- desensitization: longer, better
- flooding: faster, not as good
control with SSRI during CBT

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13
Q

panic attack path

A

random and unprovoked bouts of intense anxiety without warning

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14
Q

panic attack pt

A 
STUDENTS PANIC
Shortness of breath
Trembling
Unsteadiness
Depersonalization
Excessive heart rate
Numbness
Tingling
Sweating
Palpations
Abdominal distress
Nausea
Intense fear of losing control/dying
Chest pain
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15
Q

panic attack dx

A

r/o medical disease:

  • EKG + troponins
  • asthma
  • TSH, toxicology
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16
Q

panic attack tx

A

abort - benzo
CBT to abort without meds
control - SSRI

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17
Q

panic attack f/u

A

agoraphobia

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18
Q

intermittent explosive disorder path

A

trigger = anxiety
violent act = relief
response DISPROPORTIONATE to stressor (verbal, physical, etc)

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19
Q

intermittent explosive disorder pt

A 
2x/wk in 3 mo without harm
OR
3x in a year WITH harm
males >> females
decrease symptoms with increase age
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20
Q

intermittent explosive disorder dx

A

clx

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21
Q

intermittent explosive disorder tx

A

drugs (SSRI) = therapy (self-reflection) = drugs + therapy

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22
Q

pyromania path

A

setting fire = relief of pleasure

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23
Q

pyromania pt

A

more than 1 occasion
fire setting for decrease anxiety, increase sexual arousal, or increase pleasure
men&raquo_space; women

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24
Q

pyromania dx

A

r/o arson

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25
Q

pyromania tx

A

none - incarceration

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26
Q

pyromania f/u

A

reaction formation

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27
Q

arson

A

monetary gain

to cause harm or to destroy

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28
Q

pyromania

A

decrease anxiety
sexual arousal
pleasure

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29
Q

kleptomania path

A 
trigger = anxiety
theft = relief
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30
Q

kleptomania pt

A

steals things

  • little to no value
  • pt can afford
  • to decrease anxiety
  • gifts/hides items
  • and feels guilt/remorse
  • impulsively, alone without external provocation
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31
Q

kleptomania dx

A

r/o pety theft

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32
Q

kleptomania tx

A

none

SSRI? Therapy?

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33
Q

theft vs. kleptomania

A

theft:
- desire, able to resist, HAS value, pt CAN’T afford, planned with help or provoked by external stimuli
- used or kept, NO remorse, NO guilt
kleptomania:
- decrease anxiety, unable to resist, has NO value, pt CAN afford, Unplanned, without help, and not proved by external stimuli
- stashed, gifted, or returned, remorse, guilt

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34
Q

obsessive compulsive path

A 
obsessions = anxiety-PROVOKING thoughts, unwanted, and intrusive
compulsions = anxiety-REDUCING actions, behaviors, or mental acts
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35
Q

obsessive compulsive pt

A

obsessions: contamination, symmetry, safety
compulsions: cleaning, washing, order, counting, lock checking
at least 1hr/d
causes impairment at school, work, socially

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36
Q

OCD dx

A

clx

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37
Q

OCD tx

A

CBT is best

SSIR or clomipramine (TCA)

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38
Q

hoarding path

A

OCD about throwing things away

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39
Q

hoarding pt

A

obsessions: ridding of possessions
compulsions: retaining useless items like trash or trinkets
unsafe or cluttered home

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40
Q

hoarding dx

A

clx

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41
Q

hoarding tx

A

CBT -> SSRI

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42
Q

body dysmorphic path

A

perceived flaws in physical appearance

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43
Q

body dysmorphic pt

A

obsessions: symmetry of body, hair, skin, nose, breasts, butt
compulsions: appearance, checking, approval-seeking
attempt to have multiple surgeries to correct what isn’t broken

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44
Q

body dysmorphic dx

A

clx

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45
Q

body dysmorphic tx

A

CBT -> SSRI

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46
Q

body dysmorphic f/u

A

DO NOT perform surgery as desired

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47
Q

muscle dysmorphic disorder path

A

perceived flaws in physical appearance

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48
Q

muscle dysmorphic disorder pt

A

obsession: muscle size
compulsions: excessive exercise, anabolic steroids
roid rage, rhabdo (renal failure), testicular atrophy, ‘copper disorder’

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49
Q

muscle dysmorphic disorder dx

A

clx

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50
Q

muscle dysmorphic disorder tx

A

CBT -> SSRI

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51
Q

trichotillomania path

A

general anxiety with hair pulling

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52
Q

trichotillomania pt

A

obsessions: none in particular
compulsions: pulling out hair items like trash
alopecia with hair in different lengths

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53
Q

trichotillomania dx

A

r/o fungus (KOH prep)

r/o medical causes for alopecia

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54
Q

trichotillomania tx

A

CBT -> SSRI

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55
Q

trichotillomania f/u

A

small bowel obstruction (trichobezoar)

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56
Q

PTSD path

A

stressor
- actual death, threat death, combat, rape, abuse
exposure
- experienced (self), witnessed (strangers), learned (family), repeated exposure to effects

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57
Q

PTSD pt

A

disorder
- intrusion, neg mood, dissociation, avoidance, arousal
nightmares, flashbacks, memories
depression-like
depersonalization, amnesia
symbols, locations, memories
hypervigilence, irritability, easily startled, CHANGED concentration

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58
Q

PTSD dx

A

> 3d and <1 mo = acute stress

>1 mo = PTSD

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59
Q

PTSD tx

A

group therapy (best)
SSRI/SNRI (adjunct)
benzos (panic attack only)
CBT

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60
Q

PTSD f/u

A

mood disorder

substance abuse disorder

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61
Q

RAD/DESD path

A

stressor = neglect or abuse in infancy

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62
Q

RAD/DESD pt

A

disorder =
too much attachment (DSED)
too little attachment (RAD)

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63
Q

RAD

A

reactive attachment disorder

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64
Q

DESD

A

disinhibited attachment disorder

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65
Q

RAD/DESD dx

A

<5 y.o

r/o autism

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66
Q

RAD/DESD tx

A

caregiver - teach how to parent

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67
Q

RAD/DESD f/u

A

mood disorder

learning disabiliites

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68
Q

adjustment disorder path

A

stressor = non-life threatening event

- marital strife, loss of job, moving away

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69
Q

adjustment disorder pt

A

disorder = mood changes that don’t quite fit another mood disroder

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70
Q

adjustment disorder dx

A

begin <3mo from stressor

lasts <6mo from stressors

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71
Q

adjustment disorder tx

A

generally not needed

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72
Q

MDD path

A 
decrease mood OR anhedonia
and
>/= 2wks
AND
5 of SIGECAPS
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73
Q

MDD pt

A 
Sleep incr/decr
Interest decreased
Guilt increased
Energy decreased
Concentration decreased
Appetite incr/decr
Psychomotor decreased
Suicidal increased
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74
Q

MDD dxc

A

r/o SI

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75
Q

MDD tx

A

if + SI, + plan => hospital
if + SI, NO plan => safety contract
Combo&raquo_space; SSRI/SNRI > Psycho therapy
ECT best (refractory only)

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76
Q

Bipolar I path

A

mania = “E” + 3

duration >/= 1wk

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77
Q

Bipolar 1 pt

A 
DIG FASTER
Distractibility
Insomnia
Grandiosity
Flight of ideas
Agitation
Sexual exploits
Talkative
Elevated mood
Racing thoughts
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78
Q

Bipolar 1 dx

A

r/o Bipolar II

r/o cyclothymia

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79
Q

Bipolar 1 tx

A

ED = benzos
mood stabilizers = lithium >
- valproate backup = lamotrigine, carbamazapine
anti-psychotics = quetiapine

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80
Q

Bipolar II path

A

hypomania AND major depression

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81
Q

Bipolar II pt

A

hypomania = mania, but less

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82
Q

bipolar II dx

A

r/o bipolar I (catatonia, psychotic)

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83
Q

bipolar II tx

A

bipolar I

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84
Q

bipolar II f/u

A

if major depression, start SSRI, then have mania -> reveals bipolar I

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85
Q

dysthymia pt

A

decreased mood >/= 2yrs

symptoms not absent 2+ months

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86
Q

dysthymia dx

A

r/o hypothyroid

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87
Q

dysthymia tx

A

SSRI/SNRI

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88
Q

cyclothymia pt

A

mild bipolar II

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89
Q

baby blues

A 
baby #1, cares about baby
onset and duration within 2wks
dysthymic depression
no psychosis
no tx
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90
Q

post-partum depression

A 
> #1, doesn't care about baby, may hurt baby
onset within 1mo, ongoing
depression MDE
no psychosis
tx antidepressants
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91
Q

post-partum psychosis

A 
> #1, fears the baby, likely to kill it
onset within 1 mo, ongoing
depression MDE
psychosis + 
tx mood stabilizers or antipsychotics
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92
Q

grief

A

onset: any
duration: <12mo
focus: focused on deceased
when mood symptoms: waxes, wanes, can imagine happy
behaviors: YES insight “psychotic”, talking TO deceased, doing things as if they were there
why suicide: to be with deceased
tx: time, counseling

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93
Q

PCBD

A

onset: >/= 6mo
duration: >/= 12mo
focus: on deceased
when mood symptoms: persistent +, cannot imagine being happy
behaviors: NO insight, psychotic features
why suicide:
tx: SSRI

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94
Q

depression

A

onset: any
duration: >/= 12mo
focus: pervasive, global
when mood symptoms: persistent +, cannot imagine being happy
behaviors: NO insight; psychotic (hallucinations, delusions), talking WITH deceased, believing they are there doing things with you
why suicide: to end suffering, despondent
tx: SSRI

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95
Q

delusions

A

fixed false belief without basis in reality

do NOT confront delusion; it is a glaring truth to the patient, and you will not get anywhere by challenging them

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96
Q

schizophrenia path

A

thought disorder with unknown cause though is certainly a genetic component
receptor pathology
- dopamine (too much) -> + sxs
- serotonin (too much) -> - sxs

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97
Q

schizophrenia pt

A 
psychotic break = first break occurs in teenager with stressor (college) who then begins behaving bizarrely
positive symptoms (must have 1+)
- bizarre delusions
- hallucinations, usually auditory (voices)
- disorganized speech
- disorganized state/catatonia
Negative symptoms
- anhedonia
- flat affect
- cognitive defects
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98
Q

schizophrenia dx

A

clinical

r/o drug abuse (cocaine)

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99
Q

schizophrenia tx

A

anti-psychotics

  • typical controls positive symptoms
  • atypical controls negative symptoms
  • clozapine when all else fails
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100
Q

acute psychotic disorder

A

duration sxs: < 1 mo

duration tx: wait (or tx)

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101
Q

schizophreniform disorder

A

duration sxs: < 6 mo

duration tx: 3-6wks

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102
Q

schizophrenia disorder

A

duration sxs: >/= 6mo

duration tx: lifetime

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103
Q

schizoaffective disorder

A

duration sxs: any with mood sxs

duration tx: lifetime; tx delusions first

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104
Q

treatment options for psychotic disorders: positive symptoms

A

typical: haloperidol, thiazide, chlorpromazine

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105
Q

treatment options for psychotic disorders: negative symptoms

A

atypical: risperidone, quetiapine, olanzapine, ziprasidone, aripriprazole

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106
Q

treatment options for psychotic disorders: best

A

clozapine

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107
Q

anorexia nervosa path

A

anxiety induced by fear of being or becoming fat
patient is not fat, but fears fat; sees herself as fat
lacks recognition of how thin she is

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108
Q

anorexia nervosa pt

A

F:M 10:1, teens to 20s
severe:
- hypotension, bradycardia, leukopenia
- CMP abnormalities, electrolytes and albumin
- BMI < 16
non-severe:
- lanugo, cold intolerance, amenorrhea, emaciation

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109
Q

anorexia nervosa dx

A

clinical

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110
Q

anorexia nervosa tx

A 
hospitalize if severe
- IV nutrtion
- correct electrolytes
- forced feed
outpatient
- antipsychotics and CBT
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111
Q

anorexia nervosa f/u

A

if OCD or MDD, add SSRI/SNRI
relapse in 5yrs
death from medical or suicide

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112
Q

bulimia nervosa path

A

anxiety from the binge, then compensates

normal weight to overweight

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113
Q

bulimia nervosa pt

A

F:M 10:1; teens to 20s
normal appearance except purge signs
purge >/= 1x/wk x3mo

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114
Q

bulimia nervosa dx

A

clinical

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115
Q

bulimia nervosa tx

A

SSRI/SNRI = fluoxetine (best)

CBT

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116
Q

bulimia nervosa f.u

A

never use bupropion - causes seizures

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117
Q

binge-eating disorder path

A

anxiety from the binge - no compensation

overweight to obese

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118
Q

binge-eating disorder pt

A

F:M 10:1, teens to 20s
cannot control eating habits
binge >/= 1x/wk x3mo

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119
Q

binge eating disorder dx

A

clinical

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120
Q

binge eating disorder tx

A

topiramate

CBT

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121
Q

methods of eating disorders: restriction

A

decrease caloric intake (fasting, dieting)

increase caloric expenditure (exercise)

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122
Q

methods of eating disorders: binge purge emesis

A

eating/binging then induced emesis
dorsal hand scars (from emesis)
dental erosions (from emesis)
metabolic alkalosis, hypoK, hypoMg

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123
Q

methods of eating disorders: binge purge laxative

A

eating/binging then induced diarrhea
metabolic acidosis
diarrhea

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124
Q

personality cluster A disorders

A

paranoid
schizoid
schizotypal

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125
Q

paranoid personality disorder description

A

distrustful, suspicious

interpret others as malicious

126
Q

paranoid PD examples

A

‘enemy of the state’ gene hackman

127
Q

paranoid PD how to handle

A

clear, honest, nonthreatening

128
Q

schizoid PD description

A

loners, have no relationships, but are also happy not having any relationships

129
Q

schizoid PD examples

A

night-shift toll booth

130
Q

schizoid PD how to handle

A

you won’t see them

131
Q

schizotypal description

A

magical thinking, borders on psychosis

bizarre thoughts, behavior, and dress

132
Q

schizotypal example

A

lady gaga

133
Q

schizotypal how to handle

A

brief psychotic episodes

clear, honest, nonthreatening

134
Q

cluster B personality disorders

A

borderline
histrionic
narcissistic
anti-social

135
Q

cluster C personality disorders

A

avoidant
dependent
obsessive-compulsive

136
Q

borderline PD description

A

unstable, impulsive, promiscuous, emotional emptiness, unable to control rapid changes in mood, suicidal gestures

137
Q

borderline PD examples

A

‘girl interrupted;

‘ fatal attraction’

138
Q

borderline PD how to handle

A

suicidal gestures may be successful

splitting, dialectical behavioral therapy

139
Q

histrionic PD description

A

theatrical, attention-seeking, hyper sexual, use of physical appearance, dramatic
exaggerated but superfluous emotions

140
Q

histrionic examples

A

gone with the wind

Marilyn monroe

141
Q

histrionic how to handle

A

set rules, insist they are followed

142
Q

narcissistic description

A

inflated sense of self-worth or taken, self-centered, fragile ego, uses eccentric dress to draw attention, demands special treatment

143
Q

narcissistic example

A

zoolander

ron burgundy

144
Q

narcissistic how to handle

A

set rules, insist they are followed

145
Q

anti-social description

A

criminal, no regards for rights of others, impulsive, lacks remorse, manipulative
must be >18y/o (conduct disorder)

146
Q

anti-social examples

A

Tony soprano

the joker

147
Q

anti-social how to handle

A

jail, set rules, insist they are followed

148
Q

avoidant description

A

fears rejection and criticism, wants relationships but does not pursue them
passes on promotions

149
Q

avoidant examples

A

Napoleon dynamite

shy hot librarian

150
Q

avoidant how to handle

A

avoid power struggles, make patients choose

151
Q

dependent description

A

unable to assume responsibility

submissive, clingy, fears being alone

152
Q

dependent examples

A

stay at home mom in an abusive relationship

153
Q

dependent how to handle

A

give clear advice, patient may try to sabotage their own treatment

154
Q

obsessive compulsive description

A

rigid, orderly perfectionist
order, control
perfection at the expense of efficacy

155
Q

obsessive compulsive example

A

monk

156
Q

dissociative disorders path

A

severe + prolonged stressor causes separation of otherwise intact thought, memory, and identity

157
Q

dissociative disorders pt

A

stressor proportional to disorder

158
Q

dissociative disorders dx

A

amytal interview (truth serum)
r/o malingering
r/o substance abuse

159
Q

dissociative disorder tx

A

psychotherapy

160
Q

dissociative disorder f/u

A 
non-severe = recovery
severe = ?
161
Q

dissociative identity disorder path

A

> /= 2 distinct identity states

most severe and prolonged trauma

162
Q

dissociative identity disorder pt

A 
self experiences
- memory gaps (blackouts)
- other dissociation symptoms
others witness
- paradoxical behaviors
- appearance changes
163
Q

dissociative identity disorder f/u

A

fight club, sybil

164
Q

dissociative amnesia path

A

stressors include loss of memory

165
Q

dissociative amnesia pt

A

memory loss of

  • the event
  • regular everyday occurrences/routine
  • complete autobiographical self
166
Q

dissociative amnesia f/u

A

law and order, SVU

167
Q

dissociative amnesia with fugue path

A

stressors induce loss of memory WITH travel

168
Q

dissociative amnesia with fugue pt

A

memory loss of

  • the event
  • regular everyday occurrences/routine
  • complete autobiographical self
169
Q

dissociative amnesia with fugue f/u

A

Jason Bourne, archer from FX

170
Q

depersonalization derealization disorder path

A

adolescent with minor stressor (though stressor is relatively major for demographic)

171
Q

depersonalization derealization disorder pt

A

seeing a video or dream of self, out of body experience (depersonalization)
detached from reality, as though in a dream
reality testing INTACT

172
Q

catatonia path

A

not a disease state
modifier to another disease
psych - bipolar, depression&raquo_space; schizophrenia
heart - autoimmune, paraneoplastic, nutritional

173
Q

catatonia pt

A 
must have 3 or more:
- retarded catatonia
-- stupor
-- cata-LEPSY
-- waxy flexibility
-- mutism
-- negativism
- excited catatonia
-- stereotypy
-- agitation or grimace
-- echolalia
-- echopraxia
retarded and excited symptoms may occur together
174
Q

catatonia dx

A

clinical

lorazepam

175
Q

catatonia tx

A

lorazepam (diagnostic and therapeutic)

176
Q

malignant catatonia meds/hx

A

no meds, lorazepam corrects

177
Q

malignant catatonia sxs

A 
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
178
Q

neuroleptic malignant hyperthermia meds/hx

A

atypical antipsychotics/ lead-pipe rigidity

179
Q

neuroleptic malignant hyperthermia sxs

A 
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
180
Q

serotonin syndrome meds/hx

A

SSRI’s and hypertonicity/hyperreflexia

181
Q

serotonin syndrome sxs

A 
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
182
Q

malignant hyperthermia meds/hx

A

halothane anesthesia, family history

183
Q

malignant hyperthermia sxs

A 
rigidity
autonomic dysfunction (increase BP, HR, temp)
muscle breakdown (increase CK)
184
Q

intellectual disability disorder path - chromosomal

A

down syndrome
fragile x
cri-du-chat

185
Q

intellectual disability disorder path - maternal acquired

A

EtOH in utero

hypothyroid in utero

186
Q

intellectual disability disorder path - child acquired

A

lead poisoning

head trauma

187
Q

intellectual disability disorder pt

A

decrease cognitive skill
decrease adaptive functioning
+/- syndromic physical features

188
Q

intellectual disability disorder dx

A

clx; severity on adaptive functioning

189
Q

intellectual disability disorder tx

A

assess social, conceptual (speak, read, write), and practical (self mgmt)
special education, supervision
50-70 = group home, work and ADLs alone
25-49 = group home, ADLs alone
20-34 = institutionalized, supervised ADLs
<20 = institutionalized, total care

190
Q

tic disorder (Tourette’s) path

A

essentially OCD

191
Q

tic disorder (Tourette’s) pt

A 
onset < 18
"obsession" = impulse to perform tic
"compulsion" = the tic itself
hidden: hair flicks, blinking, rubbing
vocal: grunt, cough, yell
NEVER a swear word
192
Q

tic disorder (Tourette’s) dx

A

clx

193
Q

tic disorder (Tourette’s) tx

A

dopamine antagonists

- fluphenazine, tetrabenazine

194
Q

tic disorder (Tourette’s) f/u

A

ADHD on stimulants who gets worse is Tic disorder

195
Q

autism spectrum path

A 
impaired social communication
- social reciprocity
- social relationships 
- nonverbal communication
- joint attending
restrictive/repetitive behavior
- stereotypy
- sameness
- restricted interests
- change in perception
196
Q

autism spectrum pt

A

young child, 1-4y/o
no social smile or eye contact
repetitive useless behaviors
insistence on consistency

197
Q

autism spectrum dx

A

clx; severity based on progress

198
Q

autism spectrum tx

A

supportive

199
Q

ADHD path - impulsivity

A

blurts out answers
interrupts
fidgets a lot
cannot wait turn

200
Q

ADHD path - inattention

A

talks fast
easily distracted
fails to complete tasks

201
Q

ADHD path - timing and situation

A

> /= 2 settings
onset 7-12
duration >/= 6mo

202
Q

ADHD pt

A 
the 'ad kid' who is male, disrupts class and moves all over the place, fails to wait his turn, whose parents have a tough time controlling behaviorally, and whose like this in every setting
ensure there are no absence seizures
203
Q

ADHD dx

A

clx

204
Q

ADHD tx

A

stimulants (avoid at night d/t insomnia)

  • methylphenidate
  • dextroamphetamine
205
Q

ADHD f/u

A

special ed classes, parent education

if absence seizures, carbamazepine (ethosuximide)

206
Q

learning disabilities path

A

performing substantially below expected for age and grade

207
Q

learning disabilities pt

A

medical conditions
- deaf, blind, non-native speaker
poor education to date
- low socioeconomic class, home schooled

208
Q

learning disabilities dx

A

audiology test
vision testing
language assessment

209
Q

learning disabilities tx

A

remediate, fix the medical problem (glasses, hearing aids), fix the teacher to student ratio

210
Q

conduct disorder path

A

antisocial personality disorder but <18

211
Q

conduct disorder pt

A

bullying - hurts animals/people, uses torture/cruelty, forced sex
destruction - fire starting, lies, cheats, steals, breaks into property
rules violation - truancy, run away at least twice, staying gout at night before 13

212
Q

conduct disorder dx

A

clx

213
Q

conduct disorder tx

A

juvenile detention

214
Q

conduct disorder f/u

A

fights authority

HARMS peers

215
Q

oppositional defiant disorder path

A

incongruent parenting

teen acting out

216
Q

oppositional defiant disorder pt

A

NO bullying - does NOT hurt animals/people, does NOT use torture/cruelty, no forced sex
destruction - lies, cheats, steals, breaks into property
rules violation - truancy, run away at least twice, staying out at night before 13

217
Q

ODD dx

A

clx

218
Q

ODD tx

A

improved parenting

219
Q

ODD f/u

A

fights authority

COOPERATES with peers

220
Q

enuresis - never been dry path

A

normal toilet training takes up to 7 years old

221
Q

enuresis never been dry pt

A

if < 7 and still wets bed, NORMAL

222
Q

enuresis never been dry dx

A

clx

223
Q

enuresis never been dry tx

A

POSITIVE reinforcement
alarm blankets
water restriction before bed
DDAVP as last resort

224
Q

enuresis never been dry f/u

A

TCAs may also be used

225
Q

enuresis - was once dry path

A

regression, abuse, infection, anatomic

226
Q

enuresis - was once dry pt

A

was once dry, now is not

227
Q

enuresis - was once dry dx

A

u/a, u/s, clx

228
Q

enuresis - was once dry tx

A

infection (abx); if STI then abuse
anatomic (resection)
regression (identify stressor)
abuse

229
Q

encopresis and enuresis path

A

encopresis (stool) or enuresis (urine) repeatedly on clothes or bed

  • intentional (acting out)
  • incontinent (cognitive impairment)
  • medication side effect
  • anatomic (fistula)
  • regression (abuse, stressor)
230
Q

encopresis and enuresis pt

A

dependent on patients. look for new sibling, new step parent, or new house

231
Q

antidepressants

A 
SSRIs
SNRIs
atypical
SM
TCAs
MAOIs
232
Q

SSRIs

A 
escitalopram
citalopram
fluoxetine
paroxetine
sertraline
233
Q

SSRI side effects

A

decrease libido
delayed ejaculation
serotonin syndrome
GI, insomnia

234
Q

SNRI side effects

A

cleaner, better version of SSRI, more expensive

235
Q

SNRIs

A

venlafaxine

duloxetine

236
Q

bupropion

A

smoking cessation
no weight gain
NEVER in bulimia (increase seizures)

237
Q

mirtazapine, trazodone

A

appetite stimulant

sleep aid, caution priapism

238
Q

TCAs

A

‘-tryptylines’

  • imipramine
  • desipramine
  • doxepin
239
Q

TCAs extra info

A

used for enuresis (anti-ash)
1st line use is neuropathic pain
can be lethal because of CCC (convulsions, coma, cardiac) so get EKG
has anti-ash properties (Dry mouth, sedation, urinary retention, constipation)

240
Q

MAOIs

A

phenelzine
tranylcypromine
selegiline

241
Q

MAOIs info

A

HTN crisis when mixed together, lack of washout, or eating of tyramine (red wine/cheese)
distinguish from other hypertensive-hyperthermia disorders in psych by the ABSENCE of lead-pipe rigidity and fever

242
Q

mood stabilizers

A 
lithium
valproate
quetiapine
lamotrigine
carbamazepine
243
Q

lithium indications

A

first line, drug of choice for bipolar

bipolar, acute mania, depression augmentation

244
Q

lithium side effects

A

teratogen
nephrotoxic > 1.5 - causes neph DI
narrow TI

245
Q

valproate indications

A

first line in bipolar if Li cannot be used

also tx seizures

246
Q

valproate side effects

A

teratogen (spina bifida)
thrombocytopenia
agranulocytosis
pancreatitis

247
Q

quetiapine indications

A

second line bipolar

all phases of treatment

248
Q

quetiapine side effects

A

weight gain, QTc prolongation

249
Q

lamotrigine indications

A

second line bipolar

newer anticonvulsant

250
Q

lamotrigine side effects

A

blurred vision

SJS

251
Q

carbamazepine indications

A

third line bipolar
trigeminal neuralgia
absence seizures

252
Q

carbamazepine side effects

A

teratogen (cleft palate)
rash, SJS
AV block

253
Q

anti anxiety

A

benzos
SSRIs
ß blockers

254
Q

benzos indications

A

abort panic attack, treats EtOH withdrawal

255
Q

benzos side effects

A

dependence

withdrawal seizures

256
Q

SSRIs indications

A

first line long term medication for tx of chronic anxiety; OCD, PTSD, GAD

257
Q

SSRI side effects

A

not useful in acute attack

258
Q

ß blockers indications

A

performance anxiety

259
Q

ß blockers side effects

A

bradycardia, asthma

260
Q

typical antipsychotics

A

haloperidol
fluphenazine
thioridazine
chlorpromazine

261
Q

typical antipsychotics action

A

mesolimbic D2C-R-i
- treats + symptoms
nigrostriatal antagonism -> EPS side effects
tuberoinfundibulnar antagonism causes increase prolactin, gynecomastia

262
Q

typical antipsychotics side effects

A

potency of drug proportional to EPS

potency inversely proportional to anti-ACh

263
Q

atypical antipsychotics

A 
risperidone
quetiapine
olanzapine
aripiprazole
ziprasidone
264
Q

atypical antipsychotics mechanism

A

both D2c and 5HT1 so work on + and - sx
more selective to lower risk of EPS
currently ‘first line’ for psychosis

265
Q

atypical antipsychotics side effects

A

QTc prolongation
EPS, gynecomastia, sedation, anti-ACh (small risk)
DM and weight gain

266
Q

clozapine

A

best antipsychotic
most selective for D2c and 5HT1
drug of last resort

267
Q

clozapine side effects

A

agranulocytosis

requiring CBC q week

268
Q

extrapyramidal side effects

A

akathisia
acute dystonia
dyskinesia
tardive dyskinesia

269
Q

akathisia

A

feeling of restlessness

decrease dose, ß blockers, anti-ACh (benztropine)

270
Q

acute dystonia

A

involuntary muscle contractions, hand wringing, torticollis, and oculogyric crisis
anti-ACh (benztropine)

271
Q

dyskinesia

A

parkinsonism - dyskinesia = bradykinesia

anti-ACh (benztropine)

272
Q

tardive dyskinesia

A

irreversible hypersensitization of dopamine-R = suppressible oral-facial movements
stop drug, sxs initially worsen

273
Q

choosing a medication: compliant young adult without complications

A

any atypical po

decreased SE profile

274
Q

choosing a medication: combative ER pt

A

haloperidol depot

dedating

275
Q

choosing a medication: noncompliant psychotic

A

olanzapine depot, risperidone depot, haloperidol dept

q 1wk

276
Q

choosing a medication: dysphagia or IM not availabl

A

olanzapine ODT, risperidone ODT

oral dissolving tablet

277
Q

choosing a medication: everything else has failed

A

clozapine

best, most dangerous

278
Q

choosing a medication: hospitalized and off their meds

A

atypical, increase dose q day until maxed, then try another

279
Q

EtOH intox

A

slurred speech, disinhibition, ataxia, blackouts, memory loss, impaired judgment

280
Q

EtOH withdrawal

A

tachycardia and HTN, tremor, perspiration, hallucinations, and eventual seizures

281
Q

EtOH drug/antidote

A 
benzo taper (withdrawal)
disulfiram (long term)
282
Q

benzos intox

A

delirium in elderly

respiratory depression and coma (with increase dose), amnesia

283
Q

benzos withdrawal

A

tremor, tachycardia, HTN, seizures, psychosis

284
Q

benzos drug/antidote

A

flumazenil

285
Q

opiate intox

A

euphoria, pupil constriction, respiratory depression, and potential track marks

286
Q

opiate withdrawal

A

yawning, lacrimation, n/v, hurts everywhere, sweating

287
Q

opiate drug/antidote

A 
naloxone
methadone (long term)
288
Q

cocaine intox

A

psychomotor agitation, HTN, tachycardia, dilated pupils, psychosis
angina, HTN crisis

289
Q

cocaine withdrawal

A

depression, suicidality, irritability, ‘cocaine bugs’

290
Q

cocaine drug/antitode

A

supportive care
benzos/antipsychotics for agitation
HTN treated with α, then ß blockade

291
Q

MDMA intox

A

overheat (fever, tachycardia), water intoxication, pupillary dilation, psychosis

292
Q

MDMA withdrawal

A

crash

293
Q

MDMA drug/antidote

A

supportive

294
Q

PCP intox

A

aggressive psychosis, vertical, lateral, or rotary nystagmus, impossible strength, blunted senses

295
Q

PCP withdrawal

A

severe random violence

296
Q

PCP drug/antidote

A

haloperidol to subdue

acidify urine to enhance excretion (sodium bicarb)

297
Q

LSD intox

A

hallucinations, flashbacks, heightened senses, dissociative symptoms

298
Q

LSD withdrawal

A

flashbacks

299
Q

LSD drug/antidote

A

supportive

300
Q

THC intox

A

tiredness, slowed reflexes, conjunctivitis, munchies, OD brings paranoia

301
Q

THC withdrawal

A

none

302
Q

THC antidote/drug

A

supportive (often nothing required)

303
Q

barbs intox

A

low safety margins, benzos safer

304
Q

barbs withdrawal

A

redistribute into fat

305
Q

barbs drugs/antidote

A

none

306
Q

nicotine intox

A

none - just jittery and stimulated

pt has to overdose a lot -> VFib

307
Q

nicotine withdrawal

A

cravings

308
Q

nicotine drug/antidote

A 
bupropion
chant (varencicline)
309
Q

amphetamines intox

A

tachycardia, HTN, pressured speech, flight of ideas

310
Q

amphetamines withdrawal

A

crash

311
Q

amphetamines drug/antidote

A

none

Online Med Ed (18 decks)

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