Uworld Flashcards
BIpolar depression being treated and patient develops a rash. what caused it?
Lamotrigine - anticonvulsant but commonly used as a mood stabilizer and specifically used in bipolar depression.
10% of patients develop a drug rash. Stop the drug as son as this happens.
Drug rash happens more oftne when co-perscribed with valproate
Annorexia treatment?
CBT + nutritional rehab is first line.
IF this doesnt work then second line is olanzapine (2nd gen antipsychotic)
Hospitalize when BMI below 15 or when bradycardia, hypotension (below 80/60) or hypothermia are present
Bullemia treatment
Fluoxitine
Bupropion is contraindicated in eating disorders
Lithium toxicity
Nausea / vomitting
confusion, ataxia, tremors / fasiculations
Drug interactions (increase lithium levels with): volume depletion (decrased GFR) Thiazides Nsaids (not aspirin) ACE inhibitors Tetracyclines
What is first line treatment in bipolar depression?
1st line therapy below.
2nd gen antipsychotics: Quetiapine and Lurasidone.
Anticonvulsants: Lamotrigine
Why cant you give 1st line antidepressants in bipolar?
bupropion, citalopram, venlafaxine etc will all percipiate mania.
What do you give patients who have only had a partial response to 1st line anti-depressant therapy?
Add a 2nd antidepressant with a different MOA
however be careful to never mix a MAO-i (phenelzine) with an SSRI or TCA
OCD treatment
1st line = CBT - Exposure and response prevention techniques
+/- SSRI
SLE Diagnosis
Screening - antinuclear protein
Specific = Anti-DS DNA, Anti-SMith, Anti-U1 Ribonucleoprotein
Adjustment disorder treatment
adjustment disorder - marked distress or functional impairment within 3 months of stressor. cannot go over 6 months.
Treatment of choice - psychotherapy.
GAD
must be present for 6 months or more for diagnosis!
worry in multiple areas.
Treatment:
SSRI (buspirone) or SNRI (venlafaxine)
can add CBT
Bipolar 1 vs Bipolar 2 vs Cyclothymia
BP 1 = Mania +/- major depression (MD not required for diagnosis)
BP 2 = Hypomania and 1 or more Major depressive episodes (MUST be present for diagnosis)
Cyclothymia - 2 or more years of fluctuating hypomania and depressive episodes that never meet the criteria for hypomania or major depressive episodes
Panic disorder treatment
1st line = CBT - psychotherapy
2nd line - SSRIs or TCAs or Benzos
PCP presentation and treatment
agitation, delusions of strength, psychosis, agression, HTN , Tachy
Nystagmus (horizontal, vertical or rotary)
Treatment is supportive
for the agression give Benzos (prefferably the parenteral formulations (Lorazempam / diazepam) because agitated patients cant take meds by mouth
Haloperidol is used as 2nd line treatment in pcp intoxication resistant to benzos.
HOwever antipsychotics lower seizure threshold and are contraindicated in patients with seizures.
antisychotic contraindicatoins
seizure disorder.
antipscychotics lower seizure threshold
somatic symptom disorder vs illness anxiety disorder
somatic symptoms disorder - anxiety over 1 or more unexplained symptoms (SYMPTOMS ARE PRESENT). Patient must have this anxiety over the symptoms for more than 6 months for diangosis!
Treate somatic symptom disorder by constant follow ups with patients and minimizing specialist refferals / labs. Try CBT first if that doesnt work then 1st line pharm is an SSRI (Fluoxetine)
Illness anxiety disorder - anxiety / fear over having a specific illness when minimal or no symptoms are present!
Neuroleptic Malignant syndrome treatment
hyperthermia, autonomic instability, lead pipe rigidity, altered sensorium
Treatment:
1. STOP the antipsychotic (both 1st and 2nd gen can cause it)
- supportive care fluids / cooling (must give fludis because rhabomylsis frequently leads to myoglobinuria and kidney failure).
- Dantrolene or Bromocripitine or Amantadine.
Serotonin syndrome
Triad of autonomic instability, AMS, And Neuromuscular instability (hyperreflexia, myoclonus).
Treatment = cyprohepatadine –> serotonin antagonist.
treatment of akasthisia?
propanolol
Depersonalization / derealization disorder vs Dissociative amneisa vs Dissociative identitiy disorde
Depersonalization - Feeling like your detached form yourelf, being an outside observer of ones self.
Derealization disorder - experiencing surroundings as unreal
Dissociative amnesia - inability to recal important personal information, usually of a truamatic or stressful nature.
Dissociative identity disorder - 2 or more distint personality states
associated with severe trauma/ abuse
Bipolar 1 vs schizoaffective
In bipolar 1 disroder - the psychotic symptoms occur exclusively durring manic or depressive episodes
In Schizoaffective - delusions / hallucinations persist even when Manic / depressive episodes are not present.
