Psychiatry and Behavioral Medicine Flashcards
a 35-year-old female with a complaint of worry which she cannot control for the last year. She tells you that her symptoms daily consisting of sleep disturbances, difficulty concentrating, and irritability. She reports her symptoms started around age 17 but have worsened.
What is the likely diagnosis?
GAD
a 26-year-old first-year PA student with a medical history significant for GERD comes to your office because of frequent episodes of palpitations. The palpitations are sudden in onset and are accompanied by sweating and a sense that she is going to “pass out.” The episodes typically last no more than 10 minutes, and although the patient feels as if she may pass out, she never has. The episodes first appeared when she started PA school and have increased in frequency to the point where she is afraid to attend lectures out of fear of having an “attack.”
What is the diagnosis?
Panic Disorder
a 26-year-old first-year PA student with a medical history significant for GERD comes to your office because of frequent episodes of palpitations. The palpitations are sudden in onset and are accompanied by sweating and a sense that she is going to “pass out.” The episodes typically last no more than 10 minutes, and although the patient feels as if she may pass out, she never has. The episodes first appeared when she started PA school and have increased in frequency to the point where she is afraid to attend lectures out of fear of having an “attack.”
Given the likely diagnosis, what is the treatment
SSRI: paroxetine, sertraline, fluoxetine
Benzos for acute attacks
CBT
a lab technician calls to tell you that a 22-year-old man you have sent for a blood draw is very anxious. He says he is terrified of having his blood drawn and almost faints at the sight of the needle.
What is the diagnosis and what is the treatment
Phobia
- exposure therapy is the first line
- SSRI + CBT
- Benzos (prior to flying)
what is the treatment of agoraphobia
SSRI and CBT
How is Bipolar I characterized?
severe mood disorder with mania episode alternating with depression; psychosis during manic episodes
How is Bipolar II characterized
low-level mania with profound depression; no psychosis
How is cyclothymic disorder characterized
alternating hypomanic episodes with a long-standing low mood state (dysthymia) for at least 2 years
a 27-year-old man accompanied by his girlfriend. In the office, he seems to be running from topic to topic without a clear message. His speech is pressured. The patient’s girlfriend reports that he took steroids recently for a bad sinus infection and since he started them, his behavior has been abnormal. After discontinuing the medication, he has still been having symptoms. He has not had a normal night of sleep for the past ten days, and he just bought a new sports car though he has no need for one or the money to afford it. She also reports that she has caught him with multiple other women in the past few days, though they were in a committed relationship. The physical exam is benign and the patient’s vital signs are within normal limits.
Given the likely diagnosis - what is the first line medical management for this patient
Lithium
a 19-year-old male who has had bouts of sadness for a course of 1 year in which he says that often he cannot even get out of bed so he tells his parents he is ill. Jim states that he recently felt so energized that he could not keep his thoughts straight and jumped from one idea to another. During this energized state, he did become irritable and others stated that he was louder than usual and wondered if he took something that increased his energy. During the week of high energy, he maxed out two of his credit cards and is not sure how he will pay them off before he goes to school in the fall. It was only a week later that he became so depressed that he did not find any pleasure in anything he did, was so tired he did not want to get out of bed which has continued to be a struggle today.
What is the likely diagnosis
Bipolar II
What does SIGECAPS stand for
Sleep Disturbance
Interest lost
Guilt
Energy loss
Concentration difficulties
Appetite changes
Psychomotor agitation
Suicidal thoughts
a 26-year-old patient is complaining of depression and anxiety just prior to her menses. The symptoms have been going on for more than 1 year, but are now starting to interfere with her relationships and her productivity at work. One week prior to menses each month she experiences a depressed mood, a feeling of being on edge, increased irritability, difficulty sleeping, a feeling of being overwhelmed, and is easily fatigued. She charted her symptoms daily in a log and returned to the office two cycles later. The log is consistent with the history. Her physical examination and general laboratory profile showed no abnormalities.
What is the most likely diagnosis and treatment
premenstrual dysphoric disorder
Tx: SSRI= first line (fluoxetine, sertraline, paroxetine, escitalopram)
Birth control
SNRI
what are risk factors for suicide
male gender
older
major depression
active substance abuse
serious medical problems
recent loss
how is delerium defined
is an acute cognitive dysfunction secondary to some underlying medical condition and is usually reversible
what medication can be used for nightmares
Prazosin
what is schizoaffective disorder
Psychotic disorder featuring symptoms of BOTH schizophrenia and a major mood disorder such as depression or bipolar disorder. Symptoms may occur at the same or different times
what is schizophrenia
Psychotic disorder characterized by delusions, hallucinations, disorganized speech, and/or diminished, inappropriate emotional expression for greater than 6 months + difficulty functioning
what is schizophreniform disorder
Psychotic disorder involving the symptoms of schizophrenia for > 1 week but < 6 months and no social or occupational impairment
a 75-year-old woman has been receiving 24-hour care at home due to a fall risk. She has a history of severe diabetic neuropathy, and as a result, she is unstable on her feet. Two months ago, she began thinking that her daughter was telling her caretakers to steal her money, although both her daughter and the caretakers deny this. She continues to maintain an active social life, and cognitive testing shows no new deficit. She denies auditory and visual hallucinations and feeling like people are “out to get her.”
What is the most likely diagnosis
delusional disorder
what is the treatment of delusional disorder
psychotherapy
atypical antipsychotics - olanzapine and risperidone
a 45-year-old truck driver who c/o hearing things that are not there for 2 weeks. He reports that he was severely depressed 5 months ago and was placed on Prozac by his PCP. His depression got better and he was “fine” until 2 weeks ago when he started to “hear things.” His work and social life are not impaired by the hallucinations at this time. His friend was diagnosed with schizophrenia a few years ago and he was afraid that he now has schizophrenia.
What is the most liekyl diagnosis
schizoaffective disorder
what is the treatment for schizophrenia
atypical antipsychotics for negative symptoms
typical neuroleptics - dopamine antagonists for positive symptoms (haloperidol, chlorpromazine, thioridazine, etc)
what are negative symptoms associated with schizophrenia
blunted affect, poor posture, lack of goal-directed activities/initivative
what is the treatment of resistant schizophrenia
Clozapine or antipsychotic + another med such as benzo, cabamazepine, valproate or lithium
what is a negative side effect of clozapine
agranulocytosis
a 23-year-old male with c/o visual & auditory hallucinations that have been ongoing for 2 months. He is a graduate student at a local university, and he states that his hallucinations have been getting worse. He is still able to attend classes, but it is becoming more difficult to focus in class. His father was diagnosed with schizophrenia when he was about his age. He is currently taking no medications. His labs and imaging are all within normal range.
what is the is the diagnosis
schizophreniform disorder
what is the treatment of delirium tremens
Benzos
what is the MOA of disulfiram
(anatbuse)
inhibits acetaldehyde dehydrogenase, aversive conditioning
