Treatments Flashcards
Schizoaffective disorder?
1) Hospitalize + psychotherapy
2) Antipsychotics + mood stabilizers; antidepressants or ECT for mood sxs
Delusional disorder?
Psychotherapy, antipsychotics should be tried but usually fail
Shared psychotic disorder?
1) Separation
2) Psychotherapy and antipsychotics if sxs not improved in 1-2 wks
Rapid cycling bipolar and mixed episodes?
Anticonvulsants
Dysthymia?
CT and insight oriented psychotherapy + antidepressants
Cyclothymia?
Mood stabilizers (same as bipolar)
Adjustment disorder?
Supportive psychotherapy most effective
Panic disorder?
1) Immediate = BZDs
2) Long term = SSRIs (paroxetine and sertraline)
3) Clomipramine or imipramine maybe
Specific phobia?
CBT 1st line (not drugs!)
Social phobia?
1) Paroxetine
2) B-blockers for performance anxiety
3) Assertiveness training
OCD?
1) SSRIs or clomipramine
2) Behavioral therapy (as effective as drugs)
3) Exposure and response prevention (ERP)
4) ECT or cingulotomy
PTSD?
1) SSRIs (1st line), TCAs (imipramine, doxepin), MAOIs
2) Anticonvulsants (for flashbacks and nightmares)
3) Psychotherapy
4) Eye mvt desensitization and reprocessing (EMDR)
ASD?
Same as PTSD
GAD?
1) SSRIs/SNRI (venlafaxine)
2) Buspirone
3) BZDs (clonazepam, diazepam)
4) CBT
DTs?
1) Chlordizepoxide, diazepam, lorazepam
2) Antipsychotics for agitation
3) Thiamine, folic acid, multivitamin (banana bag)
Barb OD?
1) Alkalinize urine
2) Na bicarb
Delirium?
1) Tx cause
2) Haloperidol 1st line
2) Avoid BZDs!!!
Mild to moderate dementia?
ACEIs
Moderate to severe dementia?
Memantine
Lewy body dementia?
ACEIs for visual hallucinations
Pick’s?
Anticholinergics + antidepressants
HIV dementia?
HAART
Pseudodementia?
1) Supportive
2) Low dose SSRIs
3) If using TCAs in elderly, use nortriptyline (fewest anticholinergic AEs)
4) Mirtazapine (for appetite and sedation)
5) Methylphenidate (for psychomotor retardation)
6) ECT
ADHD?
1) Stimulants
2) Atomoxetine (nonstimulant)
3) Alpha-2 agonists (clonidine, guanfacine)
4) If underlying mood/anxiety disorder, tx that first
Tourette’s?
1) Risperidone
2) Haloperidol, pimozide (for severe cases)
Tourette’s + ADHD?
Alpha-2 agonists
Enuresis?
1) Behavioral therapy 1st line
2) Desmopressin
3) Imipramine
Dissociative disorders?
Psychotherapy
Somatization disorder?
Regularly scheduled visits with a SINGLE primary care doc
Conversion disorder?
Insight oriented psychoterhapy hypnosis, relaxation therapy
Hypochondriasis?
CBT (most useful), regularly scheduled visits to one primary care doc
Body dysmorphic disorder?
SSRIs (work 50% of time)
Pain disorder?
SSRIs, analgesics not helpful
Factitious disorder?
Avoid early confrontation
Intermittent explosive disorder?
SSRIs, anticonvulsants, lithium, propranolol, psychotherapy is not helpful
Kleptomania?
Psychotherapy, behavioral therapy, systematic desensitization, aversive conditioning, SSRIs
Pathologic gambling?
Gamblers Anonymous (12 steps) most effective
Trichotillomania?
SSRIs, antipsychotics, lithium
Pyromania?
BT, supervision, SSRIs
Anorexia?
1) Olanzapine
2) CBT
3) BZDs before meals to reduce preprandial anxiety
Bulimia?
1) Fluoxetine 1st line
2) CBT
Binge eating disorder?
1) Stimulants (suppresses appetite)
2) Orlistat
3) Sibutramine
Chronic insomnia?
CBT 1st line
Insomnia (drugs)?
1) BZDs (use short term, 4-8 wks)
2) Non-BZDs (lower incidence of daytime sleepiness and orthostatic hypotension)
3) Trazodone, amitriptyline, doxepin
Most common reason to Rx long term BZD?
Insomnia
Cataplexy?
Na oxybate (DOC), SSRIs, TCAs
Circadian rhythm disorders?
Melatonin
Sleepwalking?
Clonazepam or TCA
Sleep terror?
Clonazepam, diazepam
Nightmare disorder?
Imagery rehearsal therapy (esp in PTSD)
REM sleep behavior disorder?
Clonazepam