Psychiatry UWORLD Flashcards
Indications for ECT
- severe depression refractory to antidepressents
- depression in pregnancy
- refractory mania
- neuroleptic malignant syndrome
- catatonic shcizophrenia
Medication for refractory schizophrenia
Clonzapine
*Leukopenia SE.
Long-term SE of lithium
nephrogenic diabetes insipidus
Hyperparathyroidism w/ hypercalcemia
thyroid dysfunction
treatment of Akathisia (SE medication, dose dependent)
Reduction of antipsychotic dose and tx with beta blocker (propranolol) or a benzodiazepine (lorazepam)
conversion disorder
sudden onset of a neurological symptom (eg bilateral LE weakness) that is incompatible with normal neurological examination/ clinical findings.
precipitated by stress and patients can present as hysterical or strangely indifferent (la belle indifference) to their symptoms
somatic symptoms disorder
one or more persistent physical symptoms w/ disproportionate and excessive anxiety, concern and energy devoted to symptoms.
IN contrast to conversion, in SSD the symptoms are by definition physiological
Treatment of panic disorder immediate vs long-term
immediate: benzo
Long-term: SSRI/ SNRI/ CBT (cognitive behavioral therapy)
how long do antidepressants take to respond?
6-8 wks
tx specific phobia
behavioral therapy
Short acting benzos may help acutely but have a limited role
tx of Kleptomania
cognitive behavioral psychotherapy is tx of choice
Patient fails SSRI for depression. What is next medication?
Antidepressant with a different mechanism of action, such as serotonin norepinephrine reuptake inhibitor
Alcohol withdrawal symptoms and timing
- mild withdrawal: anxiety, insomnia, tremors, diaphoresis, palpitations, GI upset, intact oritentaion (6-24hr last drink)
- Seizures : 12-48
- Alcohol hallucinosis: visual, auditory, or tactile: intact oritentation, stable vital signs. 12-48
- Delirium tremens: confusion, agitation, fever, tachycardia, HTN, diaphoresis, hallucinations (48-96)
Which type of medication can cause seizures following abrupt discontinuation?
Alprazolam (Xanax) aka short acting benzo
important side effect of buproprion
inhibits reuptake of NE, D, 5-HT
** Decreased seizure threshold** seen in higher doses
AVOID in seizure disorder as well as eating disorders
patient on risperidone has bradykinesia, masked facies, and micrographia… what is tx?
anticholinergic: benztropine is indicated to help reduce this patient’s EPS.
Post partum blues
vs
Post partum depression
vs
Postpartum psychosis
- 2-3 days. Mild depresison/tearfulness/irritability
tx: reassurance and monitoring - within 4 weeks
Moderate-severe depression, SIGECAPS
tx: antidepressants, psychotherapy - days to weeks
delusions, hallucinations, thought disorganization, bizarre behavior
tx: antipsychotic; hospitalize– do not leave mother alone with infant – risk of infanticide
Ecstasy intoxication can cause what type of syndrome? and electrolyte change?
Serotonin syndrome: autonomic dysregulation, high fever, altered mental status, neuromuscular irritability, and seizures
Hyponatremia
Adjustment disorder with depressed mood vs MDD
adjustment disorder with depressed mood does not meet the SIGECAPS criteria for MDD
treatment for hoarding disorder
SSRI and cognitive behavioral therapy
Neuropsychiatric manifestations of SLE:
seizures headaches peripheral neuropathy strokes chorea
Social anxiety DO (social phobia)
vs
Panic DO
vs
Specific phobia
vs.
Generalized anxiety disorder
Anxiety restricted to social and performance situations, ** Fear of scrutiny** and embarrassment
recurrent, *Unexpected panic attacks
Excessive anxiety about a * specific object* or situation
Chronic (>6months) multiple worries, anxiety, tension
GAD tx:
cognitive behavioral therapy
SSRI or SNRI
Narcolepsy tx:
- Modafinil and armodafinil: address excessive, uncontrolled, daytime sleepiness.
- Amphetamine stimulants: first line except has potential risk of abuse and tolerance and SE
- Sodium oxybate: reduces cataplexy.
