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Psychiatry > Substance Related disorders + Impulse Control Disorders + Eating Disorders > Flashcards

Substance Related disorders + Impulse Control Disorders + Eating Disorders Flashcards

1
Q

Amphetamine toxicity vs anticholinergic poisoning

A

Anticholinergic poisoning has dry skin and mucous membranes, motor sx (myoclonic jerks, tremors), ileus, and urinary retention - these are not in amphetamine poisoning

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2
Q

Preggers w/ current or prev dx of anorexia nervosa are at risk for complications…

A 
Miscarriage
Intrauterine growth retardation
Hyperemesis gravidarum
Premature birth
C-section
Postpartum depression
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3
Q

Alcohol Withdrawal progression

A

6 hrs = mild WD
- anxiety, tremulous, sweating, palps

12-48 hrs = WD seizures
- seizure!

12-24 hrs = EtOH hallucinosis
- AH, VH w/ nl VS and intact sensorium

48-96 hrs = Delirium tremens

  • 5% mortality rate
  • fever
  • Hypo TN
  • tachy
  • diaphoresis
  • hallucinations
  • disorientation
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4
Q

Substance abuse criteria

A

drug use in spite of adverse consequences related to the substance

WILD for at least 12 mo

Work, school, or home role obligation failure

Interpersonal or social consequences

Legal problems

Dangerous use

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5
Q

Substance dependence criteria

A

physical or psychological need to continue taking a drug

for at least 12 mo:

Tolerance
WD
Using substance more than orig intended
Persistent desire or unsuccessful to cut down
Try to get all the time
continued use despite health problems from substance

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6
Q

Can you have substance dependence w/o physio dependence?

A

YES!

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7
Q

EtOH substance testing

A

Blood EtOH level

EtOH only in system fora few hrs

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8
Q

Cocaine substance testing

A

UDS + 2-4 days

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9
Q

Amphetamines substance testing

A

UDS + 1-3 days

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10
Q

PCP substance testing

A

UDS + 3-8 days

CPK and AST usually elevated

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11
Q

Barbituates substance testing

A

IN blood and urine

Pentobarbital = short acting = 24 hrs

Phenobarbital = long acting = 3 wks

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12
Q

Benzos substance testing

A

Blood and urine

Lorazepam = short acting = 3 days

Diazepam = long acting = 30 days

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13
Q

Opioids substance testing

A

UDS + 2-3 days

Methadone and oxycodone come up negative on general screen

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14
Q

Marijuana

A

UDS

Heavy users - 4 weeks

Single use - 3 days

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15
Q

EtOH bio effects

A

Activates:

  • GABA R
  • serotonin R

Inhibitis:

  • glutamine R
  • voltage gated calcium channels

EtOH is a depressant!!!

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16
Q

Tx EtOH intoxication

A

Monitor ABCs, glucose, electrolytes, acid base

+ thiamine
+ folate

Naloxone for co-ingested oioids

CT to r/o subdural or TBI if fell

Only do gastric lavage if a significant amount of EtOH ingested in preceding 30-60 min

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17
Q

EtOH Withdrawal progression

A

6 hrs = mild WD
- anxiety, tremulous, sweating, palps

12-48 hrs = WD seizures
- seizure!

12-24 hrs = EtOH hallucinosis
- AH, VH w/ nl VS and intact sensorium

48-96 hrs = Delirium tremens

  • 5% mortality rate
  • fever
  • Hypo TN
  • tachy
  • diaphoresis
  • hallucinations
  • disorientation
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18
Q

How many ppl w/ EtOH WD get DTs? What is mortality rate?

A

5% get DTs

Mortality rate = 15-25%

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19
Q

Sx DTs

A 
delirium
Hallucinations
Gross tremor
Autonomic instability
Fluctuating levels of psychomotor activity
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20
Q

Tx EtOH Withdrawal

A

Benzos, taper

Antipsychotics prn agitation

Thiamine, folic acid, MV

Correct electrolytes

Monitor WD w/ CIWA scale

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21
Q

At risk heavy drinking for men and women

A

Men:
>4 drinks / day
>14 drinks / week

Women:
> 3 drinks / day
> 7 drinks / week

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22
Q

Lab values in EtOH abuse

A

AST: ALT > 2:1

Inc GGT

Macrocytosis

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23
Q

Meds for EtOH dependence

A

Disulfiram

  • —| aldehyde dehydrogenase
  • not ok for severe heart dz, preggers, psychosis

Naltrexone

  • opioid blocker
  • dec desire/craving and high assoc w/ EtOH

Acamprosate

  • inhibits GABA system
  • start post detox for relapse prevention
  • can use in liver dz
  • DO NOT USE in renal dz

Topiramate

  • anticonvulsant potentiating GABA and —| glutamate R
  • reduces cravings for EtOH
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24
Q

Wernicke’s encephalopathy

A

Caused by thiamine deficiency

Acute and reversed w/ thiamine

Ataxia
Confusion
Ocular abnormalities (nystagmus, gaze palsies)

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25
Q

Korsakoff syndrome

A

Confabulations
- Pts unaware that they are making these up

Anterograde amnesia

Reversible in 20%

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26
Q

Dopamine bio effects

A

—| dopamine reuptake

STIMULANT!

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27
Q

Cocaine intoxication

A 
Euphoria
Tachy or brady
Mydriasis
Wt loss
Agitation
Cihlls
Sweating
Death 2/2
Cardiac arrhythmia
MI
Seizure
Respiratory depression
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28
Q

Tx cocaine intoxication

A

Benzos

Severe agitation or psychosis –> haloperidol

Symptomatic support (HTN, arrhythmias)

> 102 F = med emergency –> ice bath, cooling blanket

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29
Q

Tx cocaine dependence

A

Off label drugs

  • disulfiram
  • aripiprazole

Narcotics anonymous

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30
Q

Cocaine withdrawal sx

A 
Malaise
Fatigue
constricted pupils
depression
hunger
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31
Q

Amphetamines bio effect

A

Block reuptake adn facilitate release of dopamine and norepi

STIMULANT

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32
Q

MDMA bio effect

A

THis is ecstasy

Type of amphetamine

Release dopamine, norepi, and serotonin from nerve endings

Stimulant and hallucinogenic properties

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33
Q

Amphetamine intoxication

A 
Dilated pupils
Increased libido
Diaphoresis
Resp depression
Chest pain

OD:
Hyperthermia
Dehydration
Rhabdo –> renal failure

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34
Q

Chronic meth use

A

Acne

Accelerated tooth decay

35
Q

Tx amphetamine intoxication

A

Rehydrate
Correct electolytes
Tx hyperthermia

36
Q

PCP bio effects

A

AKA angel dust

antagonizes NMDA glutamate receptor
Activates dopaminergic neurons

STIMULATE OR DEPRESS CNS depending on dose

37
Q

PCP intoxication

A

RED DANES

Rage
Erythema of skin
Dilated pupils
Delusions
Amnesia
Nystagmus (horizontal, vertical, or rotary = pathognomonic)
Excitation
Skin dryness
38
Q

Tx PCP intoxication

A

Monitor vitals, electolytes

Benzos for agitation

Antipsyhotics for severe agitation

PCP can be stored in fat so watch out for “flashbacks” = recurrence of PCP intoxication sx

39
Q

Which drug withdrawal has highest mortality rate?

A

Barbituates

40
Q

Sedatives-hypnotics

- ex

A 
Benzos
Barbituates
Zolpidem
Zaleplon
GHB
meprobamate
41
Q

Sedatives-hypnotics intoxication

A 
Drowsiness
Confusion
HYPO TN
slurred speech
ataxia
respiratory depression

Sx synergistic when combo w/ EtOH

42
Q

Tx sedatives-hypnotics intoxication

A

Maintain ABCs

Activated charcoal + gastric lavage to prevent more GI absorb (if last dose 4-6 hrs ago)

BARBS only –> + Na bicarb to urine to get more renal excretion

BENZOS only –> + flumazenil in OD

43
Q

Tx sedatives-hypnotics withdrawal

A

Benzo taper

Carbamazepine or valproate taper for seizure ppx

44
Q

Which opioid + MAOI can cause serotonin syndrome

A

Meperidine

45
Q

What’s abused more - heroin or opioid medications?

A

Opioid medications

46
Q

Opioid intoxication

A 
N/V
Sedation
Dec pain perception
Dec GI motility
Miosis
Respiratory depression

Meperidine is exception to miosis –> will dilate
Demerol Dilates pupils

47
Q

Tx opioid intoxication

A

ABCs

OD –> + naloxone or naltrexone can help with resp depression but may cause severe WD

48
Q

Opioid OD signs

A

Respiratory depression
AMS
Miosis

49
Q

What do you come up + for on UDS after eat poppy seed bagels?

A

Opioids

50
Q

Tx opioid dependence

A

Methadone
Buprenorphine
Naltrexone

51
Q

Opioid withdrawal sx

A

Flu like sx - not life threatening

can start within 8 to 12 hours after the last dose and generally reach peak severity 48 hours after the last dose

Anxiety
Insomnia
Anorexia
Fever
Rhinorrhea
PIloerection

Myalgias
Tachy
HTN

52
Q

Tx opioid withdrawal

A

Clonidine for autonomic issues

NSAIDs for pain

Dicyclomine for ab cramps

If severe:
- detox w/ buprenorphine or methadone

53
Q

Hallucinogen intoxication

A

LSD, psilocybin (shrroms), mescaline (peyote)

Believed to act on serotonergic sx

Perceptual changes
Labile affect
DILATED pupils
Tachy, HTN
Hyperthermia

Can have bad trip:
anxiety
panic
psychosis

54
Q

Tx hallucinogen intoxication

A

Monitor dangerous behavior

Benzos or antipsychotics prn

55
Q

Hallucinogen withdrawal

A

No WD syndrome

With long term use, pts can experience “flashbacks” later in life

56
Q

Marijuana bio effects

A

Active component = THC

Cannabanoid R in brain —| adenylate cyclase

Can tx:

  • Nausea in chemo
  • inc appetite in AIDS pts
  • dec intraocular pressure

Dronabinol is pill form of THC

57
Q

Marijuana intoxication

A 
Euphoria
Anxiety
Dry mouth
Conjunctival injection
Increased appetite
58
Q

Tx marijuana intoxication

A

Supportive

Psychosocial interventions

59
Q

Marijuana WD + Tx

A 
Irritability
Anxiety
Restlessness
dec appetite
HA
Diaphoresis

Tx: supportive + symptomatic

60
Q

Inhalants bio effects

A

CNS depressants

61
Q

Inhalants

  • intoxication
  • OD
  • Tx
A

INtoxication

  • paranoia
  • perceptual disturbances
  • hyporeflexes
  • ataxia
  • acute intoxication lasts minutes. Stupor may last hours

OD

  • respiratory depression
  • cardiac arrhythmias

Tx

  • ABCs
  • figure out solvent as some may need chelation

WD sx rare

62
Q

Caffeine bio effects

A

Adenosine antagonist –> increases cAMP

Stimulant effect via dopamine system

63
Q

How long for caffeine WD sx to resolve?

A

1 week

64
Q

Nicotine bio effets

A

Stimulate Nicotine R in autonomic ganglia

Highly addictive through effects in dopaminergic system

Smoking –> tolerance and physical dependence

65
Q

Cigarette smoking while preggers

A

Assoc w/ low birth weight and persistent pulm HTN of newborn

66
Q

Tx nicotine dependence

A

Varenicline –> nicotinic cholinergic receptor (nAChR) partial agonist; mimics action of nicrotine and prevents WD sx

Bupropion –> partial agonist at nAChR and inhibits dopamine reuptake

Nicotine replacement therapy (patch, gum)

67
Q

Core qualities of impulse control disorders

A

Repetitive or compulsive engagement in behavior despite adverse consequences

Little control over negative behavior

Anxiety or craving prior to doing impulsive behavior

Relief or satisfaction during or after completion of behavior

68
Q

Associated lab findings in impulsive individuals

A

Low 5-HIAA concentration in CSF

Nonspecific EEG findings or abnormalities on neuropsych testing

69
Q

Intermittent explosive disorder

A

Recurrent outbursts of aggression –> assault against ppl or property

Outburst out of proportion to triggering event

Episode stops quickly and spontaneously; pt feels remorse

Men > women

70
Q

Tx intermittent explosive disorder

A

SSRI
Anticonvulsants
Lithium
Propanolol

Individual psychotherapy usually not helpful

Group therapy may be helpful to create plans to help manage episodes

71
Q

Kleptomania

A
  • can’t resist urges to steal things that are not needed for personal use or monetary reasons
  • shame and guilt after stealing

Women > men
Sx often in times of stress

1/4 pts w/ bulimia have comorbid kleptomania

Tx: insight oriented psychotherapy, behavior therapy, SSRI
- naltrexone?

72
Q

Kleptomania DDx

A

Shoplifting = theft for personal gain
Antisocial
Bipolar, manic episodes
Psychotic DO

73
Q

Pathological gambling

A

Men > women

inc incidence of mood DO, anxiety DO, OCD

1/3 get recovery without treatment

Tx:

  • Gamblers Anonymous most effective
  • insight oriented psychotherapy after 3 months of NO GAMBLING
  • tx comorbid mood disorders, anxiety DO, and substance abuse problems
74
Q

Trichotillomania

A

Uncontrollable urge to pull hair –> relief after pulling

Women > men

Tx:

  • SSRIs
  • antipsychotics
  • lithium
  • behavioral interventions
75
Q

Pyromania

A

Deliberate firesetting on more than 1 occasion

Feeling of tension or emotional arousal before setting fires

Fascination w/ fire or curiosity about situations concerning fire

Feeling of relief or pleasure from setting fires and witness their aftermath

No motive for setting fires, including financial, revenge, political, or impaired judgement from other factors (eg substance)

Not a part of conduct disorder, antisocial personality disorder, or manic episode

Tx:
behavior therapy
supervision
SSRIs

76
Q

Anorexia clinical features

A
  • Body wt < 85% of expected or BMI =< 17 kg/m2
  • Anxiety about gaining wt
  • Distorted views of body wt and shape

High serum BUN

Osteoporosis

Elevated cholesterol and carotene levels

Cardiac arrhythmias (prolonged QT)
Cardiomyopathy
Mitral valve prolapse

Euthyroid sick syndrome (hypothyroid)

H-P axis dysfunction –> anovulation, amenorrhea, estrogen deficiency

increased cortisol

Hypo Na 2/2 excess water drinking most common

77
Q

Tx anorexia nervosa

A

Outpatient unless:

  • > 20% below ideal body wt
  • Hospitalization if dehydration, electrolyte disturbances, or bradycardia

Cognitive behavioral therapy
Family therapy

Nutritional rehab

Pharm:

  • SSRIs
  • Olanzapine - if no response to above
  • Benzos before meals to relive anxiety
78
Q

What do you worry about in hospitalized anorexics?

A

Onset of anabolism, can get refeeding syndrome

  • electrolyte depletion (decreased Mg, P, Ca)
  • arrhythmias
  • heart failure

Monitor closely! Replace electolytes, slow feedings

79
Q

Bulimia

A

Recurrent episodes of binge eating

Binge eating followed by compensatory behavior to prevent wt gain (at least 2x/wk for 3 mo)

Excess worrying about body shape + wt

Maintains normal body wt

Hypochloremic hypokalemic alkalosis
metabolic acidosis (laxative abuse)
elevated bicarb
Hyper Na
Elevated BUN, amylase

Esophagities

80
Q

Tx bulimia

A

Cognitive behavioral therapy (#1)

Nutritional rehab

SSRI antidepressants 1st line med
- fluoxetine

Avoid buproprion b/c lower seizure threshold

81
Q

Russel’s sign

A

Scars or calluses on hand from contact with teeth in people who have chronic purging

82
Q

Difference between bulimia vs. anorexia w/ binging/purging

A

Anorexia is severely underweight

Bulimia has normal weight; bulimia also more ego-dystonic - sx are distressing and more likely to seek help

83
Q

Binge eating disorder

A

Binge eating at least 2 d/wk for 6 months

NO compensatory behaviors

Tx: individual psychotherapy + CBT + strict diet and exercise

  • stimulants to suppress appetite
  • Orlistat (—| pancreatic lipase –> dec amt of fat absorbed from GI)
  • Sibutramine ( –| reuptake of norepi, serotonin, dopamine)

Psychiatry (9 decks)

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