Psychiatry Flashcards
Generalized anxiety disorder Presentation
Dx, Tx
constant state of worry about MOST things on MOST days lasting for >6 months
Tx: Psychotherapy and combination with meds SSRIs
GAD symptoms needed for diagnosis
at least 3 or more somatic changes Sleep changes Weight changes Irritability Concentration changes
Panic Disorder Symptoms
STUDENTS PANIC
Acute, Overt, Catastrophic SOB Trembling Unsteady Depersonalization Excessive HR Numbness Tingling Sweating Palpitations Abdominal pain Nausea Intense fear Chest pain
Panic Disorder
Dx, Tx
ECG and troponins
TSH
Asthma
Tx: BZDs
Social Phobia
Tx
Usually in the form of public speaking
Non selective beta blockers
Intermittent Explosive disorder
Presentation
Dx, Tx
Stressor that leads to violence, Disproportionate to the stressor
Mild: 2x/ week for 3 mo No harm
Severe: 3x/ ever for 12 mo Harm to others
Kleptomania
Presentation
Dx, Tx
Steals things, there is rarely any value, patient can usually afford the object
Patient usually has guilt or remorse
OCD
presentation
Dx, Tx
made of obsessions and compulsions
obsessions are internal, intrusive and unwanted
Compulsions: reduce anxiety
Tx: SSRI
PTSD
Presentation
Mood Change Dissociation Avoidance Hypervigilance Stressor is severe, life threatening
PTSD
Dx, Tx
> 6 months duration
Tx: SSRI/SNRI
Adjustment disorder
Presentation
Dx, Tx
Stressor is non-life threatening
Mood changes
Dx: Onset >3 days but <1 month
Tx: Usually none
RAD/DSFD
Presentation
Dx, Tx
Abuse/neglect in the family RAD=pairs too little DSFD=pairs too much Dx: <5 years old r/o Autism
Major Depressive Disorder
Presentation
decreased mood or anhedonia and Duration > 2 wks and 5 SIG E CAPS Sleep decreased or (increased in atypical) Interest decreased Guilt Increased Energy Decreased Concentration Decreased Appetite decreased (increased Atypical) Psychomotor retardation decreased Suicide
Major Depressive Disorder
Dx, Tx
R/o Suicidal ideation
SSRI/SNRI
Suicidal ideation with a plan
Hospitalize
Suicidal ideation with no plan
Contract the patients safety
Bipolar I
Presentation
Manic predominant duration > 1 wk E + 3 Sx Distractability Insomnia Grandiosity Flight of ideas Agitation Sexua exploits Talkative Elevated Mood Racing thoughts
Bipolar I
Dx, Tx
r/o Stimulants r/o bipolar II, cyclothymia Tx: Agitated=BZDs Mood stabilizer 1. Lithium 2. Valproic Acid 3. Lamotrigine 4. Quetiapine
Bipolar II
Presentation
Hypomania with a MDE
Shared features of Grief, PCBD, MDE
Dysphoria, Guilt, Anhedonia
Grief Presentation
Onset anytime duration <1 year focus on the deceased Can imagine a happy time sadness waxes and wanes (+) insight no treatment
Persistent complex bereavement disorder Presentation
Onset > 6 months after Duration >12 months focus on the deceased never happy ever, sadness is persistent Hallucinations, no insight Tx: SSRI/ SNRI
MDE Presentation
onset at anytime duration >12 months Focus on themselves never happy, cannot see an end to sadness Hallucinations Tx: SSRI/SNRI
Baby blues Presentation
Moms 1st baby and mom cares onset 2 weeks duration 2 weeks depressed mood no treatment
Postpartum depression presentation
second baby, mom doesnt care leading to neglect onset within one month duration-ongoing MDD symptoms Tx: SSRI
Postpartum psychosis presentation
second baby, mom fears baby onset within 1 month duration-ongoing symptoms of psychosis Tx: Antipsychotics
Schizophrenia
Presentation
Tx
(+) symptoms-too much dopamine (-) symptoms-too much serotonin >2 symptoms one being 1-3 1. delusions 2. hallucinations 3. disorganization 4. disorganization 5. flat affect/poverty of speech/movement Tx: antipsychotics
Brief Psychotic disorder duration
> 1 day but <1 month
Schizophreniform Duration
> 1 month but <6 months
Schizophrenia duration
> 6 months
Schizoaffective disorder Presentation
Psychosis and mood symptoms
Atypical antipsychotics
Normal patient
Quetiapine
olanzapine
risperidol
Combative patient which antipsychotic
Haloperidol
Non-compliant patient which antipsychotic
depot form-haloperidol
when all other antipsychotics fail what to use?
clozapine -can cause agranulocytosis
Cluster A personality Disorders
Weird
Paranoid
Schizoid
Schizotypal
Cluster B personality disorders
Wild
Histrionic
Narcissitic
Antisocial
Cluster C Personality Disorders
Weak, Shy, timid
Avoidant
Dependent
Obessive-compulsive
Neuroleptic Malignant Syndrome Presentation
Psych Disease
Positive Antipsychotic Medications
autonomic dysfunction- increased HR, BP, Temp
Serotonin Syndrome Presentation
Psych disease
SSRI
Hypertonicity/Hyperreflexia
Treatment durations in MDD
> 6 weeks at a single dose
6 months at effective dose
6 weeks of washout
SSRI medications
(es)Citalopram
Fluoxetine
Paroxetine
Sertraline
SSRI Adverse Effects
Sexual Dysfunction
decreased libido
Prolonged ejaculation
SNRI Medications
(des)venlafaxine
Duloxetine
Atypical Antidepressants
Buproprion
Tx: Smoking
no weight gain
Do not use in bulimia
Mirtazapine uses
Appetite stimulation
Trazadone uses
sleep aid
can cause priapism
CAGE questions
Cut down
Angry
Guilty
Eye opener
Alcohol intoxication presentation
Chronic Presentation
AMS Disinhibition Slurred Speech Cerebellar Dysfunction Chronic: Wernicke's Korsakoff (irreversible)
How to treat Alcoholic coma
- Thiamine
2. D50
Acohol withdrawl=BZD withdrawl
Presentation
Tx
Diastolic HTN/Tachycardia, Termor, Diaphoresis, agitated, Confusion (delirium Tremens), Seizure
Tx: Long-Acting BZD-Chlordiapoxide, diazepam
and
Short-Acting BZD-Alprozolam/Lorazepam
Opiate use
Presentation
Tx
Intoxication-euphoria, coma, decreased RR, Constricted pupils
Long-term use-Constipation
Withdrawl-pain, N/V/D, cramping, irritability
Tx: acute-Naloxone
BZD
presentation
Withdrawl
Tx
Delirium in the elderly, decreased Resp rate, coma, amnesia
HTN, Tachycardia, Seizures, Psychosis
Flumazenil
Cocaine
presentation
withdrawl
Tx
Psychomotor agitation, HTN, Tachycardia, psychosis, dilated pupils, angina, HTN crisis
depression, cocain bugs
alpha blockade THEN beta Blockade
Amphetamines
presentation
withdrawl
Tx
dilated pupils, psychosis, overheating (fever/tachycardia), Water intoxication
Crash, Depression
Supportive treatment
PCP
presentation
withdrawl
tx
aggressive psychosis, vertical and horizontal nystagmus, impossible strength, blunted senses
severe random, violence
haldol, acidify the urine to increase excretion
LSD
Presentation
Withdrawl
Tx
Rare, hallucinations, flashbacks, increase senses
flashbacks
supportive treatment
Marijuana
Presentation
Withdrawl
Tx
tired, slowed reflexes, conjunctivitis, munchies, paranoia
no withdrawal symptoms
supportive treatment
Barbituates
Presentation
Withdrawl
Tx
decreased safety margin, decreased respiratory rate, coma
redistributes into fat
OSA
presentation
Dx, Tx
Daytime Somnolence, Obese, snoring, large tongue, short neck Dx: Polysomnography >15 apnea spells/hr >5 apnea + snoring Tx: CPAP Lose weight
Narcolepsy Dx test
CSF-Hypocretin 1
polysomnography
Primary Insomnia treatment
Diphenhydramine
Trazadone
Quetiapine
Zolpidem
Illness Anxiety disorder
previously hypochondriasis
preoccupied with acquiring illness
unwanted
requires reassurance
Symptom Somatic disorder
Somatic symptoms such as fatigue or pain
unwanted
Conversion disorder
Neurologic symptom occuring due to some stressor
wont harm self
unwanted
Factitous disorder
any kind of symptoms
patient wishes to fulfill a role possibly to achieve attention
intentionally deceive
Malingering
any kind of symptoms
patient is doing due to secondary gain
intentionally deceiving
