Step 2 Psych Flashcards
How is Tourettes D/O dx’d? What pharm options do you have? What comorbid conditions are associated?
Dx = multiple motor and vocal tics that cause relief for at least one year before 18 yo; can wax and wane.
Pharm therapy is indicated when the d/o interferes with daily living; first gen anti psych rx haloperidol and pimozide are FDA approved but b/c of potential SEffx (QTc prolong), 2nd gen are preferred (esp. Risepridone)
Associated with OCD
What factors make a person more predisposed to lifetime therapy for Bipolar Mood D/O? What med has been shown to decrease suicide, relapse, and hospitalization in these pts?
Fam hx, >3 episodes, severe episodes
LITHIUM!
What would you do and give a patient who recently started an antipsychotic and is experiencing hyperthermia, muscle rigidity, autonomic instability, and altered sensorium? What’s happening? What are you watching out for as a possible complication?
Give Dantrolene Sodium, a direct muscle relaxant and immediately stop the neuroleptic, it’s causing Neuroleptic Malignant Syndrome.
Can also continue supportive care with cooling, antipyretic meds, electrolyte and fluid repletion.
Look out for Rhabdomyolysis as evidenced by elevated CPK levels - give alkaline diuresis for suspected rhabdo to prevent acute renal failure.
Describe Reaction Formation, Sublimation, Splitting and Suppression.
1) Reaction Formation = neurotic mech = doing the exact opposite of what makes you mad (i.e. being furious with homeless people but volunteering at a homeless center)
2) Sublimation = mature mech = downgrading an instinctive response and doing something that is acceptable (go boxing when you want to punch someone out of anger)
3) Splitting = “all good” or “all bad” mentality
4) suppression = avoiding an uncomfortable idea by occupying yourself with other things
What are the two 1st line trmts for Generalized Social Anxiety D/O?
CBT and SSRI
Dx psychosis for:
1) < 1 month
2) > 1 month but < 6 months
3) > 6 months
1) Acute Psychosis
2) Schizophreniform
3) Schizophrenia
What’re the +/- sympt of Schizophrenia?
Pos: delusions, hallucinations, bizarre behavior, thought disorder (respond well to antipsychotics)
Neg: Flat affect, anhedonia, alogia, poor attention, avolition (respond poorly to typical anti psych meds but better response found with atypical anti psych meds)
Schizophrenia predictors of bad/good outcome:
Bad Outcome: fam hx, early onset, neg sympt, poor support, no precipitating factors, and MOST IMPORTANTLY poor premorbid functioning
Good Outcome: MOST IMPORTANTLY good premorbid functioning, late onset, positive sympt, good support, married
Does psychotherapy help outcomes in Schizophrenia?
YES
What to watch out for with high potency (Haloperidol), low potency (Chlorpromazine), and Atypicals (Risperidone, Olanzapine, Aripiprazole, Paliperidone, Quetiapine, and Ziprasidone)?
1) EPS
2) Autonomic Dysfxn
3) Less incidence of auto dysfxn than above
*Auto Dysfxn = anticholinergic (dry mouth, urinary retention, blurry vision, mydriasis) / alpha blockade (orthostatic hypotension) / antihistamine effects (sedation)
Define acute dystonia, who does it predominate in, trmt?
In the first couple of hrs - days of anti psych meds, MALES predominately, develop muscle stiffness (torticollis, opisthotonus, oculogyric eye crisis, etc) - treat with antihistamines (diphenhydramine) or anticholinergic (benztropine, trihexphenidyl)
Give ______ for akathisia.
Beta-blockers (occurs days after meds given)
How do you treat parkinsonism s/p anti psych meds?
Most commonly presents in older woman months after trmt started - treat the same as acute dystonia. (2/2 to dopamine blockade by meds)
What do you do with a pt p/w Tardive Dyskinesia?
Occurs many months to years s/p trmt - no definitive treatment except for taking them off the meds and consider switching to atypical.
Galactorrhea, impotence, menstrual dysfxn, and decreased libido can result from anti psych meds b/c….
They block/inhibit dopamine and dopamine is a prolactin-inhibiting hormone.
Side Effects of:
1) Thioridazine
2) Clozapine
3) Chlorpromazine
4) Olanzapine
5) Quetiapine
6) Ziprasidone
7) Aripiprazole
8) Paliperidone
1) Retinal pigment deposits
2) Agranulocytosis which is why you monitor WBC’s
3) Photosensitivity and jaundice
4) Wt gain, hypotension, sedation dry mouth (AVOID in overtly overweight patients BC HIGH INCID OF DM and WT GAIN)
5) Sedation, orthostatic hypotension, akathisia, wt gain, dry mouth
6) Nausea, weakness, QT prolongation (AVOID IN PATIENTS W/ CONDUCTION D/O)
7) HA, nausea, akathisia, tremor, constipation
8) Parkinsonism, dystonia, dyskinesia, akithisia, QT prolongation
Trmt for acute mania in BP d/o vs. BP depression?
1) Lithium, valproic acid, and atypical antipsychotic
2) Lithium, Lamotrigine
- WATCH THE KIDNEYS WITH Lithium
Side Effects of Lithium, Valproic Acid, and Carbamazepine:
1) Kidney dysfunction (diabetes insipidus), thyroid dys, tremor, CNS probs
2) Liver Dys
3) Bone marrow suppression = aplastic anemia & SIADH
Differentiate BP I, BP II and Cyclothymia:
BP I is mania with depression, BP II is hypomania w/ depression (no psychosis w/ mania and no effect on occupation), vs. 2 yr hx of hypomania and mild depression WITHOUT full-blown manic or major depressive states
T/F: When pt’s symptoms begin to improve from depression. they are at an increased likelihood of suicide?
Yes - they might get enough energy to do it!
Age groups most likely to commit suicide?
> 65 yrs old; age 15-24 experiencing highest increase in rate
Define dysthmia:
Depressed mood on most days for more than 2 years w/o episodes of major depression, mania, or psychosis
What to give a pt with a possible TCA-induced arrhythmia? (prolonged QRS complex)
Sodium Bicarbonate - would see hyperthermia, seizures, hypotension, anticholinergic effects including dilated pupils, flushed dry skin, and intestinal ileus
When would you consider giving MAOI’s? What two med classes to not prescribe with?
May be good for atypical depression (hyperphagia/hypersomnia) when it doesn’t respond to other meds. DONT GIVE WITH SSRI’s or MEPERIDINE!!!!
What side effect is feared by men with Trazodone?
Priapism
What distinguishes normal grief from pathologic grief?
Normal: generally, up to 1 yr of normal SIGECAPS, yearning for lossed person >1 yr, searching for deceased too, hallucinations with insight that they are hallucinations
Abnormal: suicidal ideation, psychomotor retardation, and feelings of worthlessness
Agoraphobia is associated with what psych d/o?
Panic D/O
Drug consideration for GAD…
Buspirone = slow onset, nonsedating, nonaddictive
SSRI’s = use if concurrent depressive sympt
BZD = warning with addiction and sedation
Differentiate b/w Somatization D/O, Conversion D/O, Hypochondriasis, and Body Dysmorphic D/O
Somatization D/O is when a pt has multiple vague symptoms in different organ symptoms with no precipitating factor for many years and negative work up
Conversion D/O occurs with a specific factor and a unexplainable neurological symptom
Hypochondriasis is when the pt persistently believes something is wrong despite negative w/u
Body Dysmorphic D/O whereby a pt is fixated on a physical defect that doesn’t exist or is hugely blown out of proportion
Differentiate b/w somatiform, factitious, and malingering d/o’s…
Somatiform d/o comprises symptoms that are not made up by the patient, it’s an unconscious process. Factitious d/o is where the pt actually creates the illness or the symptoms to assume the “role of the pt” but NO secondary gain. Malingering happens when pts intentionally create their symptoms in attempts of secondary gain!
What is classically associated with a history of childhood abuse?
Dissociative Identity D/O
Difference b/w Schizoid, Avoidant, Antisocial and Borderline Personality D/O’s?
Schizoid - alone and WANT to be alone
Avoidant - avoid social environments but WANT to have friends
Antisocial - past hx of Conduct D/O; set fires, cruel to animals, lie and have no remorse for their actions, male predominance
Borderline - unstable moods, behaviors, and relationships. Look for splitting!!! Might have micro psychotic episodes.
Dx: pt has decreased latency to REM sleep, cataplexy, hypnagogia and hypnopompic…Trmt?
Narcolepsy. Modafinil
MCC’s of mental retardation?
MC preventable cause = Fetal Alcohol Syndrome
MC overall = Down Syndrome
Male-specific cause = Fragile X
How to differentiate autism from Asperger Syndrome?
Asperger’s has intact language skills with the impairment of social activities and restricted interests. VS Autism w/ all three: impaired social interactions, impaired verbal and nonverbal communication, and restricted interests.
