U World Flashcards
Major depressive disorder affects the physiology of the brain how?
Hyperactivity of HPA axis
Results in increased cortisol levels
Pt w/bipolar that has elevated Cr should get what Med?
Valproic acid
How does Major depressive disorder effect REM sleep latency?
Slow-wave sleep?
Decreases
Decreases
What are the MC side effects of Methylphenidate?
Dec appetite
Weight loss
Insomnia
Pt that is constantly walking around nonstop after starting new antipsychotic has developed what?
Treat how?
akathisia
Dec dose, give Propanolol or benzotropine/Benzo
What is high imminent risk in suicide assessment?
High non-imminent risk?
Ideation, intent and plan
Ideation, intent but NO plan
Pt that has depression, fatigue, hypersonic, increased dreaming, hyperplasia, and impaired concentration most likely has what?
Cocaine withdrawal
Pt that has been hospitalized 5 times in the last 3 years most likely has what?
Treat how?
Relapses d/t noncompliance
Give a long acting injectable
What meds can decrease serum Lithium levels?
Theophylline
K+ sparing diuretics - spironalactone
Pts w/Dementia w/LB are extremely sensitive to antipsychotics, what can they cause?
Confusion
Parkinsonism - rigidity
ANS dysfunction
What is the most specific indicator of dementia?
Getting lost in familiar territory
Pt w/anxiety, irritability, mood swings, grandiosity and psychotic sx w/borderline tachycardia, HTN, diaphoretic, has mild tremors, and dilated pupils has what going on?
Cocaine use disorder
Neuroimaging of Schizophrenia shows what findings?
Enlargement of cerebral LATERAL ventricles
Panic disorder has what common sx?
Cardiorespiratory
GI distress
Parenthesis
Dissociative sx
ECT causes what SEs?
Retrograde AND anterograde (2 weeks) amnesia
How do you treat oppositional defiant disorder?
Psychotherapy - anger management training and social skills training
What is Schizoaffective disorder?
Major depressive or manic episode w/sx of schizophrenia
Lifetime hx of delusions/hallucinations for > 2 weeks in ABSENCE of MD or manic episode
Mood Sx present for majority of illness
Bipolar disorder that is not adequately controlled with mono therapy is treated how?
Add a 2nd gen antipsychotic
Performance situation anxiety is a subtype of what?
Social anxiety disorder
What is the MAJOR distinguishing feature of Binge-eating disorder?
NO compensatory behavior
Recurrent binge eating w/lack of control
Catatonia is treated how?
BENZOs or ECT
Pt that has recurrent awakenings from REM sleep associated w/full alertness and dream recall has what?
Nightmare disorder
What is the MAJOR distinguishing feature of Bullimia nervosa?
Compensatory behavior (vomiting or Exercise) to prevent weight gain
Normal body weight
1st line treatment for anorexia nervosa?
CBT
High fever, mental status change, ANS instability, rigidity indicates what?
What causes it?
NMS
Antipsychotics —> olanzapine
Pt that suddenly gets dysphoria, insomnia, fatigue, and myalgia after suddenly stopping SSRI has what?
Treatment?
Antidepressant discontinuation syndrome
Restart med, then gradually taper
What is it called when there is a dream enactment during REM sleep if muscle Antonia is absent?
REM sleep behavior disorder
What non-psychiatric meds can cause psychotic disorder?
What sx?
High dose glucocorticoids aka Prednisone
Delusions, hallucinations
What medication is used to treat NMS?
Dantrolene or Bromocriptine
1st line treatment for ACUTE mania are what?
Antipsychotics - Olanzapine
Pt w/Major depression that fails to respond to initial SSRI at MAX dose should have what done next?
Switch to different SSRI
What is persistent complex bereavement disorder?
Depressive sx but sadness CENTERS on loss of loved one characterized by intense yearning for deceased
Timeline of Schizoaffective disorder?
LIFETIME hx of delusions/hallucinations for > 2 weeks w/no major depression
Agranulocytosis = what?
Neutropenia
Pt w/unexplained ABD pain and new onset neuropsychiatric symptoms including neuropathy, anxiety, mood change, and psychosis may have what?
AIP
Borderline pts have what common history?
Hx of childhood abuse
Adjustment disorder defined how?
Treatment?
Emotional/behavioral sx that start within 3 months of an Identifiable stressor, ends w/in 6 months
Psychotherapy
What is the Major features of antisocial personality disorder?
Violating rights of others with NO remorse
PMHx of conduct disorder sx before age 15
Pt with new onset of severe GI sx, confusion, ataxia, tremor and eventually seizures due to what medication?
Lithium toxicity
Li toxicity causes what symptoms?
What drug can interact to cause this?
GI distress, confusion, ataxia, tremor/fasciculations
NSAIDs
Long term SEs of Li include what?
Nephro DI
CKD
Hyperparathyroidism w/hypercalcemia
Thyroid dysfx
Structural abnormalities in orbitofrontal cortex and striatum (BG) are found in what disorders?
OCD
What demographic does REM sleep behavior disorder occur in?
May be a sign of what?
Older men
PD or Dementia w/Lewy Bodies
Pt w/prolactin level of 70 has what?
If over 200?
Risperidone SE
PRLoma
Pt that is depressed but also has hallucinations has what?
Can Treat how?
Major depression w/psychotic features
ECT or SSIR + anti-psychotic
OTC cold and cough meds can cause what in children?
Hallucinations and confusion —> psychosis
If you are considering PMS/prementrual dysphoria disorder what do you need to do first?
Treat mild how?
Mod to severe?
Keep menstrual diary
Exercise and stress-reduction
SSRI
How long do you continue SSRI treatment after a pt tells you they feel better and not depressed anymore?
6 months
Chronic mood disturbance characterized by > 2 years of numerous periods of hypomanic and depressive sx that are subthreshold for Dx major depressive or hypomanic/manic episodes is what?
Cyclothymic disorder
Postpartum blues occurs when?
Peaks when?
WITHIN 2 weeks!!!
Day 5
What defines obsessive-compulsive PERSONALITY disorder?
Perfectionist, preoccupied with order
Have RIGID rules and details
15 y/o boy w/transient euphoria and LOC that lasts only for 15-45 minutes is abusing what?
What other sx?
Inhalants
Dermatitis in mouth or nose
What are the MC used treatments acute PCP intoxication?
#1 - BENZOs Haldol
What labs/tests do you need prior to starting Lithium?
BMP
Ca
Thyroid fx tests
UA
What does Pramipexole treat?
PD and Restless leg syndrome
Serotonin syndrome can occur with what drug drug interaction?
SSRI and MAOI
Chronic depressed mood for > 2 years and NO sx-free period for > 2 months w/poor appetite, insomnia, low E/self-esteem, hopelessness indicates what?
Persistent depressive disorder (dysthymia)
Depressed mood MORE days than not for > 2 years and 2 other depressive sx
Sexual assault increases pt’s risk of what?
Suicide
What is the 1st line treatment for school-aged children w/ADHD?
Stimulants - methylphenidate or amphetamines
Elderly pts that present w/new onset insomnia with other depressive sx should raise concern for what?
Major depressive disorder
What is psychodynamic psychotherapy?
Used to develop insight into past, unresolved conflicts and change maladaptive defenses
it is NOT THE SAME as CBT
What electrolyte abnormalities do bulimics have?
HypoK
HypoCl
Metabolic alkalosis
How to tell the difference bw PD w/dementia and Dementia w/Lewy body?
If Parkinsonism symptoms (TRAP) PREDATES cognitive impairment by > 1 year, then it is PDD
What drugs interact with Lithium?
Thiazides diuretics NSAIDs ACE-i’s Tetracycline Metronidazole
Pt with acute psychosis with hallucinations needs to be what?
Hospitalized
Pt that is on a SSRI for depression and after 2 weeks says he is eating and sleeping better BUT still depressed, what should you do?
Continue for 2-4 weeks
Adequate SSRI requires 4-6 week trial
Pt that has ADHD with history of substance use disorder treated with what?
Atomoxetine
What causes an adverse side effect in the elderly which is manifested by recurrent episodes of confusion, aggression, disinhibition and agitation w/in 1 hour after taking the medication?
What is this called?
BENZOs
Paradoxical agitation
BENZOs are generally not recommended in the elderly bc of what risks?
Cognitive impairment
Falls
Paradoxical agitation
Treatment for Body dysmorphic disorder?
SSRI +/- CBT
Pediatric depression presents w/symptom most often?
Irritability rather than depressed mood
Pt that hears voices and seeing animals when falling asleep and feels weak in face and knees after talking to gf and is experience daytime sleepiness has what?
What are those 2 things called?
Narcolepsy
Hypnagogic hallucinations and cataplexy (loss of m. Tone in response to emotion)
Guys can also have what personality disorder?
Borderline
Social anxiety disorder is characterized by what?
Anxiety and FEAR of scrutiny in social situations
Results in avoidance, distress, social-occupational dysfx
Pt that has failed 2 trials of antidepressants from the same class (ie SSRI) should be started on what?
New antidepressant w/different MOA
Pt experiencing Acute stress Disorder, what is the best step in management/treatment?
Educate the pt about range of rxns to trauma —> CBT
Which SSRI has a short half-life?
Long half-life? How long?
Paroxetine
Fluoxetine (4-6 days)
Recurrent, unexpected panic attacks and FEAR about future attacks or maladaptive behavior related to attacks is what?
Some pts may develop what?
Panic disorder
Agoraphobia
What medical conditions can cause psychosis in kids?
SLE
Thyroid dysfunction
CNS infection
Electrolyte disorder
Tardive dyskinesia is a result of what neurotransmitter dysregulation?
Dopamine receptor super sensitivity
What is agoraphobia?
Anxiety and avoidance of >/= 2 situations in which it may be difficult to escape or get help (being outside the home or in enclosed spaces, using transportation) in the event of a panic attack
