UW3 (02 Psych) Flashcards
Extrapyramidal
Sudden contraction
Neck / Tongue / Eye
Torticollis + Ocullogyric crisis
Diagnosis?
Treatment? 2
Acute Dystonia
DiphenHydramine
Benztropine
Extrapyramidal
Restlessness
Diagnosis?
Treatment? 3
Akathisia
Propranolol
Lorazepam
Benztropine
Extrapyramidal
Gradual onset
Tremor
Rigidity
Bradykinesia
Diagnosis?
Treatment? 2
Benztropine
Amantadine
Extrapyramidal
Gradual onset
Dyskinesia
Mouth / Face
Trunk / Extremities
Diagnosis?
Treatment? 2
Tardive Dyskinesia
Valbenazine
Deuterabenazine
Major depression - diagnosis
Duration?
What complications if no treatment?
> 2 weeks
CV disease risk increase
Depression > 2y
Diagnosis?
Persistent depressive disorder
= Dysthymia
Adjustment disorder
Timeline criteria?
Functional dysfunction onset < 3m after stressor
Depression
Treatment indication?
If responsive to SSRI but has side effects?
What should be added in addition to medication for moderate/severe?
Is it safe to use at CV disease?
symptom > 6m
Different SSRI type
Add therapy
Safe with CV disease
Insomnia at elderly
First line treatment?
Others? 4
Cognitive Behavioral therapy
Sleep hygiene
Sleep restriction
Stimuli control
Relaxation techniques
Schizophrenia with depression or mania
Delusion or hallucination > 2 weeks without depression or mania
Diagnosis?
Schizoaffective disorder
Acute stress
Timing?
When is it considered PTSD?
1st line therapy?
Duration 3d-1m
PTSD if > 1y
CBT + medications @ insomnia or anxiety
Lithium toxicity
Risks / Trigger? 3
Management? 3
When is dialysis required?
AKI
Hypovolemia (Thiazide / ACE-I)
NSAID
Li check q24h
IVF
Bowel irrigation
Dialysis
- Li > 4
- Li > 2 with symptom or AKI
Personality disorder:
Excessive emotion
Attention seeking
Histrionic vs Borderline difference?
Histrionic
Inappropriate social behavior
Suggestiveness
Borderline
Manipulative
Self injury / SI
Identity disturbance
Schizophrenia treatment
for positive symptoms? (general)
for negative symptoms?
Anti-psychotics
Pyschosocial:
social skills
employment service
Androgenic steroid abuse - symptoms
Typical at Male? 1
Typical at Female? 4
Common for both? 1
Aggression
Eating disorder
Clitoromegaly
Hair loss
Deep voice
Mood disorder
Diagnosis criteria
Provisioal tic?
Chronic tic?
Tourette? - complications? 2
Tic < 1y
Motor / Vocal tic > 1y
Multiple motor + Vocal tic > 1y
OCD / ADHD
Tourette
Treatment? 4
CBT (habit reversal)
Antipsychotic
1 - fluphenazine / Pinozide / Haloparidol
2 - Risperidone / Aripiprazole
Alpha blocker (clonidine / guanfacine)
Dopamine deplete (tetrabenazine)
Bipolar treatment:
Hypo/Mania episode while on anti depressant? 2
Severe mania? If worsen?
Stop: anti depressant
Start: mood stabilizer or Anti psychotic g2
Start: Lithium / Mood stabilizer / Valproate
Add: anti-psychotics
ADHD
1st management?
Medication Indication?
Behavioral therapy
Age > 6y
Failed behavior therapy
Severe impairment
ADHD medication
What organ system HPI & PE is needed?
What test is NOT needed?
Does it increase risk for substance abuse?
Cardiac
Monitor weight & VS
NO EKG needed
Not increase subspace abuse risk
Smoking withdrawal symptoms? 5
Smoking cessation treatment? 4
Restlessness Anxiety / Restlessness Reduced concentration Insomnia Depression
Behavioral
Nicotine replacement
Varenicline
Bupropion
Bupropion
Effects on weight?
Avoid at? 2
Decrease weight
Avoid at seizure & eating disorder
Sleep Terror
Initial management?
Typical course?
When does it require medication? which one?
Reassurance & Education only
Spontaneous resolution within 1-2y
Benzo @ high freq or sig impaired function
Parkinson medication therapy
Mechanism of causing psychosis?
3 management steps?
Elevated Dopamine
Stop/Reduce: adjunct meds
Reduce: Levo/Carbi dopa
Add: quetiapine / clozapine / pimavanserin
Treatment resistant depression
(with partial response)
Management? 5
Augment (add) Anti depressant Anti Psychotics g2 Lithium Thyroid hormone Psychotherapy
Treatment resistant depression
(with NO response)
Management?
1 - Switch anti depressant
2 - psychotherapy
3 - ECT
4 - transcranial magnetic stimulation
Benzodiazepine
Withdrawal symptoms? 10
Tachycardia Hypertension Hyperthermia Restless / Irritable Anxiety / Panic Insomnia Tremor Psychosis Seizure Death
Lithium
Medication types that increases Li? 4
Medication types that decreases Li? 2
Medications types that caused mixed Li changes? 2
Thiazide
NSAID (∅ Aspirin)
ACE-I / ARB
Anti-Biotics
K sparing diuretics
Theophylline
Loop Diuretic
CCB
Anorexia Hospitalization criteria (10)
Hemodynamic instability HR < 40 BP < 80/60 Dizziness / Syncope Orthostatic change Hypothermia
Refeeding BMI < 15 Refusal to eat Suicidal Psychosis
OCD
Treatment? 4
- Exposure & Response therapy
- SSRI
- Clomipramine (TCA)
- Anti psychotics
Behavioral therapy for conditions:
- Borderline
- OCD
- Depression
- Childhood problems
- Stress / Coping
- Dialectical
- Exposure & Response
- InterPersonal
- PsychoDynamic
- Supportive
Alcohol abuse
1st line treatment
Psycho/Social
Alcohol treatment:
- Naltrexone (mechanism, effects & indication, contraindication 2)
- Acamprosate (mechanism)
- Disulfiram (use indication)
- Mu antagonist
Reduce craving & drinking (start while drinking)
CI @ opioid / hepatitis or liver failure - Glutamate modulator
- highly motivated & not drinking
Steroid induced psychiatric symptoms? 6
Mood symptoms Psychosis Anxiety Sleep disturbance Restlessness Memory loss
Panic attack
- Initial treatment
- medication for acute episode?
- SSRI/SNRI + CBT
2. Benzo
SLE - labs
General & findings? 5
Serology? 4
Hemolytic Anemia
Plt ↓ / WBC ↓ / Cr ↑
ProteinUria
C3 ↓ / C4 ↓
ANA
Anti-dsDNA
Anti-Smith
Somatic Symptom
- Timing criteria?
- Main management?
- 4 goals?
- Distress or Impairment > 6m
- Regular office visits
- Functional improvement
Stress reduction
Coping strategy
Mental health referral
Anti psychotics at dementia
Increased mortality cause 3
CV event
Fall
Aspiration pneumonia
Catatonia
Treatment? 2
Lorazepam
ECT
Alcohol withdrawal symptom / timing
- 6-24h (4)
- 12-48h (2)
- 48-96h (7)
- Is Benzo safe to use at liver disease?
- Anxiety / Insomnia / Tremor / Sweat
- Hallucination / Seizure
- Delirium / Confusion / Hallucination / Agitation / T ↑ / HR ↑ / BP ↑
- Yes
PCP intoxication treatment
For mild? 1
For severe or violence? 2
Reduce stimuli
Benzo / Lorazepam
Haloperidol
Serotonin syndrome vs Neuroleptic malignant
Medication causes? 5 / 1
Presentation differences? 3 / 2
Management? 3 / 1
SSRI / SNRI TCA Tramadol MAOI / Linezolid MDMA
Tremor / MyoClonus / HyperReflexia
BradyKinesia / Muscle Rigidty -------------------------------------------------- Strop Medications / Support Benzo Cyproheptadine (serotonin antagonist)
Dantrolene
Anxiety / Agitation / Delirium
Diaphoresis / BP ↑ / HR ↑ / T ↑
Nausea / Vomiting / Diarrhea
On psychiatric medication
Differential Diagnosis? 2
Serotonin syndrome
Neuroleptic Malignant Syndrome
Tobacco effect at pregnancy:
Maternal effects? 5
Fetal effects? 7
Pre-Eclampsia Placenta previa Placental abruption PPROM Spontaneous abortion
Congenital defects SGA Fetal demise DM Asthma Obesity Sudden infant death
Schizophrenia
Good prognosis factors:
Timing? Gender? Onset / Trigger ? Symptom types? FH? Duration?
Late onset Female Acute onset / Trigger Positive >> Negative No FH Short duration
Believe death is:
Temporary
Reversible
Disbelief
age group?
Age < 6y
Sexual dysfunction @ SSRI
Management? 4
- r/o medical cause
- Switch to bupropion / mirtazapine
- Add: sildenafil / bupropion
- Reduce SSRI dosage & monitor
St. John’s Wort
Common uses? 3
Medication interactions? 7
Anti-depressant
Anti-inflammatory
Wound healing
OCP Anti-RetroViral ImmunoSuppressant Narcotics Anti-Fungal Anti-Coag Serotonin syndrome risk ↑ @ SSRI/SNRI
Substance abuse referral
Indication for OP? 3
Indication for IP? 6
Highly functioning
Highly motivated
Has Good support system
Severe Intoxication / Withdrawal Comorbidities Poorly functioning Low motivation Poor support
PTSD
Diagnosis?
Treatment? 2
Medication for nightmare?
Nightmare / Flash back > 1m
CBT
SSRI / SNRI
Prazosin @ nightmare
Varenicline
Psychiatric side effects? 3
Treatment?
Agitation
Depression
Suicidal
Bupropion
