Step 2 Flashcards
treatment for acute dystonia
Anticholinergics i.e. Benztropine (antimuscarinic, antihistamine + inhibits dopamine transporters) or Diphenhydramine (antihistamine)
treatment for tardive dyskinesia
1st line: reduce dose of antipsychotic or change to alternative
2nd line: VMAT2 i.e. valbenazine, deutetrabenazine
treatment for akathisia
1st line: reduce dose or alternative antipsychotic
2nd line: anticholinergic i.e. benztropine or benzodiazepines i.e. lorazepam
treatment for neuroleptic malignant syndrome
discontinue medication
supportive care
dantrolene
treatment for dyskinesia (parkinsonsim induced by antipsychotics)
1st line: reduce dose or alternative
2nd line: anticholinergic (benztropine) or dopamine agonist (amantadine)
serotonin syndrome vs neuroleptic malignant syndrome
21-year-old man has 3 months of social withdrawal, worsening
grades, flattened affect, and concrete thinking
schizophreniform disorder
schizophrenia requires 6 months
atamoxetine mode of action
norepinephrine reuptake inhibitor
stimulants side effects
decreased appetite (weight loss)
irritability
insomnia
anxiety
headache
tic exacerbation
decreased growth velocity
mode of action of clonidine and guanfacine
alpha agonist
used 3rd line in ADHD
inheritence of Rett syndrome
X linked
differential diagnoses to autism
intellectual disability, global developmental delay
selective mutism
hearing impairment
Rett syndrome (usually female, characteristic hand wriggling)
Fragile X (X linked prominant, long face, high arched palate, macro-orchidism etc)
treatment for autism
- education
- behaviour management (applied behavioural analysis therapy)
- medications to treat symptoms i.e. neuroleptics for aggression and mood instability, stimulants or alpha agonists for ADHD, SSRI for behaviour, anxiety and mood
what is disrupted mood dysregulated disorder
A pattern of severe, recurrent verbal or behavioral outbursts that are out of proportion to the situation and a persistently irritable or angry mood between outbursts.
■ Symptoms must occur for ≥1 year; they may progress to depression in
adulthood.
■ DMDD should not be diagnosed before 6 years of age or after 18 years
of age.
most common chromosomal cause of intellectual disability
trisomy 21
most common inherited cause of intellectual disability
fragile X
most common preventable cause of intellectual disability
foetal alcohol syndrome
how is the severity of intellectual disability categorised
based on level of support needed with ADL’s
IQ score not used in new DSM-5
diagnostic criteria for tourettes
multiple motor tics
one or more vocal tic
present for > 1 year
persistent (occur almost every day/multiple times per day)
best initial treatment for tourettes
behavioural therapy - habit reversal therapy
vocal tic only lasting > 1 year - diagnosis?
persistent tic disorder
medication management for tourettes syndrome
1st line: dopamine depleting - VMAT2 i.e. tetrabenzaine
2nd line: dopamine blocking - antipsychotics i.e. fluphenazine, risperidone
3rd line: typical antipsychotics i.e. haloperadol, pimozide
Alpha agonists (clonidine, guanfacine) better side effect profile but not as effective
what is caprolalia
seen in tourettes syndrome
repetition of obscene words
diagnosis of schizophrenia
2 or more of the following symptoms for > 6 months. At least one symptom must be hallucination, delusion or disorganised speech
hallucination
delusions
disorganised speech
dysfunctional or catatonic behaviour
negative symptoms (anhedonia, avolition, flattened affect, social withdrawal)
what is an illusion
illusion = an abnormal perception of an external stimulus
hallucination = perception in the absence of an external stimulus
schizotypal vs schizoid
schizotypal = weird beliefs
schizoid = loner
mechanisms of typical antipsychotics
dopamine (D2) antagonists
high potency = haloperidol, fluphenazine
low potency = thioridazine, chlorpormazine
what atypical antipsychotic is worse for hyperprolactinaemia
risperidone
what atypical antipsychotic is worse for QTc prolongation
ziprasidone
difference in side effect profile of arpiprazole compared to other typical antipsychotics
doesnt cause hyperprolactinaemia due to partial agonist activity
what somatic symptoms are required for the diagnosis of GAD
worry/anxiety for >6 months with 3 or more of the following somatic symptoms (only require 1 in children)
Worry Warts
wound up (irritability)
worn out (fatigue)
absent minded (poor concentration)
restlessness
tense muscles
sleep disturbance
mode of action of buspirone, side effects and why it may be chosen over 1st line SSRI and SNRI for anxiety
buspirone = 5HT partial agonist
no sexual side effects unlike the SSRI and SNRI’s
side effects: headache, dizziness, nausea
main side effects of SNRI’s
e.g. venlafaxine, duloxetine
hypertension
stimulant effects
main side effects of SSRI’s
sexual dysfunction
GI upset
nausea
somnolence
agitation
indication for propraolol in anxiety disorder
only indicated for performance-only social anxiety disorder
1st line treatment for the following panic disorders;
- social anxiety
- performance-only social anxiety
- specific phobia
- agoraphobia
social anxiety: SSRI/SNRI +/or CBT
performance-only: propranolol
specific phobia: CBT
agoraphobia: CBT, SSRI
alternative to benzodiazepines for a patient with anxiety + history of substance abuse
phenelzine (MAO inhibitor)
medication used to treat PTSD related nightmares
prazosin (alpha blocker)
MMSE and Moca scores diagnostic of dementia
MMSE < 24
MOCA < 26
1st and 2nd line treatment for alzheimers
1st line: cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
2nd line: NMDA antagonists i.e. memantine
treatment for seasonal depression
light therapy
side effects of ECT
antegrade amnesia
arrythmias
post ictal confusion
headache
what SSRI should be avoided in pregnancy and why
paroxetine
1st trimester - cardiac defects, 3rd trimester - pulmonary HTN of newborn
side effects of TCA’s
i.e. amitryptilline, imipramine
antihistamine - sedation, weight gain
anticholinergic - dry mouth, dry eyes
antiadrenergic - orthostatic HTN
cardiac - QT prolongation
pnemonic for the symptoms of mania
DIG FAST
Distractability
insomnia
grandiosity
flight of ideas
agitation/ activities
sexual indiscretion/ other pleasurable activities
talkativeness
treatment for mania/hypomania in pregnancy
1st line is typical antipsychotic as they have fewer risks to developing foetus compared to mood stabalisers
may also have ECT for severe depression
hypnagognic vs hypnopompic hallucinations
hypnagognic - occurs when going to sleep
hypnopompic - occurs when wakening
found in narcolepsy
management of narcolepsy
regimen of daily scheduled naps plus stimulants i.e. amphetmines or modafinil
cataplexy requires SSRI’s
primary hypersomnia vs narcolepsy
both characterised by excessive daytime sleepiness but narcolepsy is due to hypocretin deficiency (found on CSF sampling)
diagnosis of EDS is excessive daytime/nigh somnolence for at least 1 month
diagnosis of narcolepsy is excessive daytime somnolence and reduced REM sleep at least 3x/week for 3 months
OSAS vs central sleep apnoea treatment
OSAS: CPAP
CSA: BiPAP
side effects associated with OSAS
hypertensios (systolic)
pulmonary hypertension
headache
depression
cor pulmonale
