Shelf Facts Flashcards
Mania mnemonic
DIG FAST
distractibility
irritable mood
grandiosity
flight of ideas
agitation/increase in goal directed activity
speedy thoughts/speech thoughtlessness: see pleasure without regard to consequences
suicide risk mnemonic
SAD PERSONS sex- male age > 60 depression previous attempt ethanol/ drug abuse rational thinking los organized plan/access no support sickness
depression mnemonic
SIG E CAPS sleep interest guilt energy concentration appetite psychomotor changes suicidal ideation - hopelessness, helplessness, worthlessness
alcohol intox/withdrawal
Intox - disinhibited, mood lability, incoordination, slurred speech, ataxia, blacouts, respiratory depression
Withdrawal - tremulousness, hypertension, tachycardia, anxiety, psychomotor agitation, nausea, seizures, hallucinations, DT
benzo intox/withdrawal
Intox - disinhibited, mood lability, incoordination, slurred speech, ataxia, blackouts, respiratory depression
Withdrawal - tremulousness, hypertension, tachycardia, anxiety, psychomotor agitation, nausea, seizures, hallucinations, DT
Bar intox/withdrawal
Intox - respiratory depression
Withdrawal - anxiety, seizures, delirium, life-threatening CV collapse
opioids intox/withdrawal
Intox - CNS depression, nausea, vomiting, sedation, decreased pain perception, decr GI, pupil constriction, resp depression
Withdrawal - increase dsympathetic activity, N/V/D, diaphoresis, rhinorrhea, piloerection, yawning, stomach cramps, myalgias, arthralgias, restlessness, anxiety, anorexia
amphetamines, cocaine intox/withdrawal
Intox - euphria, increased attention, aggressiveness, agitation, pupil dilatation, hypertension, tachy, cardiac arrhythmias, psychosis
Withdrawal - post use crash, restlessness, HA, hunger, severe depression, insomnia/hypersomnia, strong psychological testing
PCP intox/withdrawal
Intox - belligerence, impulsiveness, agitation, vert/horizontal nystagmus, hyperthermia, tachy, ataxia, psychosis, homicidal
Withdrawal - recurrence of symptoms from reabsorption in GI
LSD intox/withdrawal
Intox - altered perception, elevated mood, panic, flashbacks
Cannabis
Intox - euphoria, anxiety, paranoia, slowed time, social withdrawal, increased appetite, dry mouth
nicotine/caffeine intox/withdrawal
Intox - restlessness, insomnia, anxiety, anorexia
Withdrawal - irritability, lethargy, headache, increased appetite, weight gain
DT’s - timing, sx, tx
2-4 days
delirium, agitation, fever, autonomic hyperactivity, auditory and visual hallucinations
benzos and hydration
NMS - sx, tx
fever, rigidity, autonomic instability, clouding of consciousness
withhold neuroleptics, hydrate, consider dantrolene
Serotonin syndrome - sx, tx
AMS, fever, agitation, tremor, myoclonus, hyperreflexia, ataxia, incoordination, diaphoresis, shivering, diarrhea
stop agents, cyproheptadine
tyramine reaction/HTN crisis - cause, sx, tx
tyramine foods while on MAOI
HTN, HA, stiff nec, sweating, nausea, vomiting, visual problems, stroe, death
phentolamine
Dystonia - sx, tx
muscular spasm, eyes, tongue, jaw, neck
benztropine or diphenhydramine
medical causes of psychosis
CNS disease: alz, parinson, HD, tertiary syph, epilepsy, prion disease
endocrin: addison/cushing disease, hyper/hypo thyroid, yper/hypo calcemia, hypopit
nutritional: B12, folate, niacin
Other: SLE, porphyria
timeline of schizophrenia and phases
positive or negative sx for at least 6 months
prodromal - decline in functioning ie socially withdrawn and irritable
psychotic - perceptual disturbances, delusions, disordered thought
residual - occurs between psychosis, flat affect, social withdrawal, odd behavior
negative symptoms of schizo mnemonic
5 A's anhedonia affect (flat) alogia (poverty of speech) avolition (apathy) attention (poor)
Types of schizophrenia
paranoid - delusions and auditory hallucinations, older age of onset
disorganized type - disorganized speech, behavoir, flat or inappropriate affect –> poor functioning
catatonic type - rigid posture, inappropriate or repetitive and purposeless movements, echolalia, echopraxia
residual type - negative symptoms
undifferentiated - does not fit in others
drugs that mimic schizo
cocaine and amphetamine
predisposing factor to paranoid schizophrenia
deafness
schizophreniform timeline
1-6 months
schizoaffective disorder
have major depressive, manic or mixed
have delusions or hallucinations for 2 weeks in absence of mood disorder
mood symptoms for substantial portion of psychotic illness
not related to drugs
what do patients with schizoaffective disorder progress to
schizophrenia (60-80%)
brief psychotic disorder
psychotic symptoms 1 day to 1 month
delusional disorder - occurs, sx, tx
most common in older patients, immigrants, hearing impaired
nonbizarre, fixed delusionsfor at least 1 month
not schizophrenic
functioning
major depressive disorder time course
2 weeks of depressed mood and anhedonia with at least 4 other symptoms
mania time course
elevated expansive or irritable mood for at least 1 week
mania vs hypomania
mania causes severe impairment in social functioning and may have psychotic features
hypomania - no psychotic features, no marked impairment
major depressive disorder - prevalence and age
16.2% and 40
major depressive disorder - sleep problems
- multiple awakenings
- initial and terminal insomnia
- hypersomnia
- REM shifted
major depressive disorder with atypical features - description and tx
mood reactivity, leaden paralysis, hypersomnia
tx: MAOIs
bipolar disorder 1 - prevalence and tx
1%, age before 30
tx: lithium, anticonvulsants, atypical antipsych, ECT (pregnancy or refractory tx)
bipolar disorder 2 - description, prevalence, tx
major depressive episodes with hypomania
prevalence - more common than bipolar 1, age before 30
dysthynmic disorder - description
chronic mild depression, no episodes for at least 2 years
- sx not gone for > 2 months
- tx cognitive therapy or antidepressant meds
- never have psychotic features
cyclothymic disorder
alternating hypomania and mild depressive symptoms
- at least 2 years, never been sx free for > 2 months
- no major depressive episodes and no manic episodes
adjustment disorder - time course
symptoms witin 3 months of stressor and end within 6 months, impairment in daily functioning or interpersonal relationships
- not life threatening event
panic attacks/disorder - tx
SSRIs (paroxetine and sertraline)
- clomipramine and imipramine, benzos
performance anxiety - tx
propranolol
social anxiety - tx
paroxetine (SSRI)
OCD - prevalence and tx
2-3%, distressed by sx
tx: SSRIs, TCAs
PTSD vs acute stress disorder timeline
ASD 1 month, lasting 1 month
GAD - tx, time course
6 months
Tx: SSRIs, SNRIs
paranoid personality disorder
suspicion, no evidence, preoccupation with doubts of loyalty or trustworthiness, reluctance to confide in others
- more common in men
- family members of schizo
schizoid personality disorder
social withdrawal, no desire for close relationships and prefer to be alone
- more common in men
schizotypal personality disorder
eccentric behavior and peculiar thought patterns, strange and eccentric
- odd beliefs or magical thinking
- can go to schizophrenia
antisocial personality disorder
more likely in men with alcoholic parents
- no remorse for actions, impulsive and deceitful, violate law
- at least 18, history of conduct disorder
- coexistence of substance abuse and/or major depression common
- DBT and behavioral therapy
borderline personality disorder
unstable moods and interpersonal relationships, fear abandonment, poorly formed identity, aggression common due to impulsive
- unstable relationships, impulsivity, unstable mood/affect, unstable self image
- splitting, patients all good or all bad
- more ocmmon in women
tx: psychotherapy, behavior/cognitive
histrionic personality disorder
attention seeking behavior and excessive emotionality - dramatic
- need to be center of attention
- inappropriately seductive or provocative behavior
- uses physical appearance to draw attention to self
2-3%
psychotherapy
narcissistic personality disorder
superiority, need for admiration, lack of empathy
5 or more
- exaggerated self importance
- preoccupation with unlimited money, success, brilliance
- believes that he or she is special or unique
<1%
psychotherapy
avoidant personality disorder
social inhibition and intense fear of rejection
- avoid social interaction and seek jobs without interpersonal contact
- desire companionship
1-10%
psychotherapy, beta blockers for anxiety sx
dependent personality disorder
poor self-confidence and fear separation, need to be taken care of
- regression often seen in patients
- clinging behavior
1%
psychotherapy
OCPD
pattern of perfectionism, inflexibility, orderliness
- prefectionist
- loves rules and lists
- no delegating
men
psychotherapy
substance abuse prevalence
17%
alcohol dependence prevalence
3-5%
alcohol withdrawal symptoms begin
6-24 hours, last 2-7 days
DTs time course
48-72 hours
DTs death
15-25% mortality if untreated, only 5%
altruism
mature defense
- acts that benefit others to experience pleasure
humor
mature defense
- expressing unpleasant or uncomfortable feelings without causing discomfort to self or others
sublimation
mature defense
- satisfying socially objectionable impulses in an acceptable manner
suppression
mature defense
- ignoring an unacceptable impulse or emotion to diminish discomfort and accomplish a task
order of medications in possible alcohol withdrawal
thiamine, then glucose/fluids/benzos
PCP intox pathognomonic
rotatory nystagmus
delirium + hemiparesis or focal signs and sx
CVA or mass lesion
Dx: brain CT/MRI
delirium + elevated BP + papilledema
HTN encephalopathy
Dx: Brain CT/MRI
delirium + dilated pupils + tachy
drug intox
Dx: urine tox
delirium + fever + nuchal rigidity + photophobia
meningitis
Dx: LP
delirium + tachy + tremor + thyromegaly
thyrotoxicosis
Dx: T4, TSH
dementia with stepwise increase in severity and focal neuro signs
multi infacrt dementia
Dx: CT/MRI
dementia + cogwheel + resting tremor
lewy body dementia, parkinson
Dx: clinical
dementia + gait apraxia + urinary incontinence + dilated cerebral ventricles
NPH
Dx: CT/MRI
dementia + obesity + coarse hair + constipation + cold intolerance
hypothyroid
CT/MRI
dementia + diminished position and vibration + megaloblasts
vit B12 deficiency
serum B12
dementia + tremor +_ abnl LFTs + kayser fleischer rings
wilson disease
ceruloplasmin
dementia + diminished positiion and vibration + argyll robertson pupils (no response to light)
neurosyphilis
CSF FTA-ABS or CSF VDRL
five stages of grief
denial anger bargaining depression acceptance
prolonged grief time course
6 months
delusions in alzheimer patiernts (%)
70%
hallucinations in dementia pateints (%)
33%
mentally retarded cases are mild
85%
MR affects % of population
1-3%, majority guys
ODD
negativistic, hostile, defiant behavior x 6 months
- get along with peers, no regard for authority figures
- 2-16%
- age 3-8
Conduct disorder
1 year need to have 3/15
- aggression toward people and animals
- destruction of property
- deceitfulness or theft
- serious rule violation
1-10%
basic rights of others or social norms violated
Comorbid conditions with conduct disorder
ADHD (70%) and learning dosrder, substance abuse
premorbid condition for conduct disorder
antisocial personality disorder
comorbid condition with ODD
ADHD, substance abuse, mood disorders
ADHD prevalence
5-12%, 60% to adulthood
% of autism meet criteria for MR
70%
asperger vs autism
asperger have normal language and cognitive development
rett disorder
between 5-30 months decreased head growth and loss of hand skills, impaired language, retardation
- suually girls
- MECP2 on x chromo
childhood disintegrative disoder
normal development 2 years of life. loss of previously acquired skills before age 10 in at least 2
- language, social skills, bowel or bladder continence, play, motor skills
tourette’s criteria
multiple motor and one or more vocal tics not due to CNS disease prior to 18
- no tic free for > 3 months
stimulants exacerbate tics
ADHD and tourette’s %
50%
age for separation anxiety
7 months to 6 years
stranger anxiety
8-12 months
sexual abuse in women %
15-25%
sexual abuse in men %
5-15%
dissociative fugue
sudden unexpected travel away from home, inability to reall one’s identity or one’s past
- not aware they have forgotten everything
somatization disorder - sx, prevalence, PCP
multiple nonspecific sx not from medical condition or substance (onset before 30)
- at least four pain sx
- at least two GI sx
- at least one sexual or reproductive sx
- one pseudoneruological sx not limited to pain
0.1-0.5%
5-10% patients in primary care have disorder
conversion disorder
at least one neuro sx not explained medically
- psychologticqal stressor precedes sx
- patient calm and unconcerned about sx
- not intentionally produced
only disorder equally common in men
hypochondriasis
tx of pain syndrome
SSRI, biofeedback, hypnosis, psychotherapy
factitious disorder
patients want to assume sick role, intentionally produce medical or psychological sx
- only primary gain no secondary gain (money etc)
malingering
feigning physical or psych sx for personal gain
- avoid police, room and board, money, narcotics
- more common in men
amount of bulimia nervosa patients with comorbid klepto
1/4
2 types of anorexia nervosa
restrictive type - OCPD, no binge eating or purging
binge-eating/purging - eat in binges with self induced vomiting, using laxatives, excessive exercise, diuretics
sx of anorexia
amenorrhea, cold intolerance/hypothermia, hypotension, bardycardia, arrhythmia, ACS, alopecia, edema, dehydration,
laboratory abnl of anorexia
hyponatremia, hypochloremic hypokalemic alkalosis, arrythmia, transaminitis, leukopenia, anemia, BUN, increase GH, increase cortisol
prevalence of anorexia and treatment
1%
tx: outpatient with food unless 20% below or serious medical problems
- behavioral therapy
refeeding syndrome
malnourished patients refed too quickly, fluid retention and decreased phosphorus, magnesium, calcium
sx: respiratory failure, delirium, seizures
tx: replace electrolytes and slow feedings
2 types of bulimia
purging type - vomiting laxatives enema or diurectics
nonpurging type - excessive exercise or fasting
time course of bulimia and prevalence
binge eating and compensatory behaviors 2 times a week for 3 months
1-4%
laboratory findings in bulimia
hypochloremic hypokalemic alkalosis, metabolic acidosis with laxative, elevated bicarb, hypernatremia, incr BUN, incr amylase
tx for bulimia
antidepressants + therapy
SSRIs, fluoxetine`
most common hypersomnia
breathing-related disorders, sleep anea
dyssomnia prevalence and crtieria and tx
5-10%
> 1 month to years, reduced quality of life, increase risk of psych
tx: sleep hygiene, CBT**, benzo (reduce sleep latency and nocturnal awakening)
insomnia antidepressent with depressive sx
trazodone
narcolepsy - sx
excessive daytime sleepiness and falling asleep at inappropriate times
- at least 3 months
- cataplexy
- hallucinations
hypnagogic hallucination
transitioning to sleep
hypnapompic hallucination
transitioning from sleep
sleep walking prevalence
1-4%, 10-20% in children and adolescents
sleep walking tx
sleep hygiene, behavioral, clonazepam, benzo, TCA
sleep terror - sx, prevalence, tx
sudden arousal with screaming from slow wave sleep
1-6% children, 1-2% adults
tx: condition is benign and self-limited, low dose benzo in adults
tx of nightmare disorder
imagery rehearsal therapy - use mental imagery to modify the outcome of recurrent nightmare, writing down improved outcome
tx of REM sleep beahvior disorder
clonazepam, imipramine, carbamazepine, pramipexole, levodopa
gonadal hormone that lowers libido/sexual function in men and women
progesterone and serotonin
hormone that increases libido
dopamine
most common sexual disorders in women
sexual desire disorder and orgasmic disorder
most common sexual disorders in men
secondary erectile disorder and premature ejaculation
paraphilias time course
unusual sexual urges or fantasies for at least 6 months, cause impairment in daily functioning
3 most common paraphilia
pedophilia, voyeurism, exhibitionism
tx of paraphilias
aversion therapy, insight oriented psychoterapy, behavior therapy, pharmacologic therapy (antiandrogens)
displacement
immature defense
- shifting emotions from undesirable situation to one that is tolerable
intellectualization
immature defense
- avoid negative feelings by using reasoning/ focusing on irrelevant details
isolation of affect
immature defense
- limiting experience of feelings or emotions to avoid anxiety, unconscious
rationlization
immature defense
- explanation of event to justify outcomes
- ie my boss fired me because she is short tempered and impulsive, not my fault
reaction formation
immature defense
- doing the opposite of unacceptable impulse
- man in love insults woman
repression
immature defense
- unconscious, preventing thought or feeling from entering consciousness
projection
immature defense
- attributing objectionable thoughts or emotions to others
- husband attracted to other women believes wife is having an affair
splitting
immature defense
- labeling person all good or all bad
biofeedback
used to treat migraines, HTN, chronic pain, asthma, incontinence
- physiological data is given to patients as they try to mentally control physiological states
cognitive behavioral therapy
used for psychiatric illness - depression, anxiety, substance abuse
psychoterapy tx of borderline
DBT, decreases self destructive behaviors and hospitalizations
malpractice mnemonic
4 D’s
- deviation from duty that was the direct cause of damage
positive sx of schizo pathway
mesolimbic dopamine pathway (nucleus accumbens, forxnix, amygdala)
negative sx of schizo pathway
mesocortical pathway dopamine
EPS pathway
dopamine nigrostriatum
prolactin pathway
tuberoinfundibular
