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Psychiatry > Dz Treatment > Flashcards

Dz Treatment Flashcards

1
Q

Tx of schizophrenia (sxs for >6 months)

A
  1. Pharmacotherapy (first or second gen)
  2. Behavior therapy
  3. Family therapy and group therapy
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2
Q

Chlorpromazine

A

first-gen antipsychotic

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3
Q

Thioridazine

A

first-gen antipsychotic

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4
Q

Haloperidol

A

first-gen antipsychotic

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5
Q

trifluoperazine

A

first-gen antipsychotic

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6
Q

common s/e’s of first gen antipsychotics

A

EPS, neuroleptic malignant syndrome (NMS), tardive dyskinesia

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7
Q

risperidone

A

second-gen antipsychotic

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8
Q

clozapine

A

second-gen antipsychotic

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9
Q

olanzapine (zyprexa)

A

second-gen antipsychotic

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10
Q

quetiapine (seroquel)

A

second-gen antipsychotic

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11
Q

aripiprazole (abilify)

A

second-gen antipsychotic

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12
Q

ziprasidone (geodon)

A

second-gen antipsychotic

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13
Q

common s/e’s of second-gen antipsychotics

A

metabolic syndrome (HTN, hyperinsulinemia, central adiposity, HLD)

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14
Q

extrapyramid symptoms (EPS)

A

dystonia, parkinsonism, akathisia

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15
Q

treatment of EPS

A

antiparkinsonian agents (benztropine, diphenhydramine), benzos, beta-blockers (specifically indicated for akathisia)

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16
Q

“weight-neutral” second-gen antipsychotics

A

aripiprazole, ziprasidone

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17
Q

neuroleptic malignant syndrome (NMS)

A

autonomic changes, lead pipe rigidity, elevated CPK, leukocytosis, metab acidosis

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18
Q

tx of schizophreniform disorder (sxs for 1-6 months)

A
  1. hospitalization
  2. 3-6m course of antipsychotics
  3. support psychotherapy
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19
Q

tx of schizoaffective d/o

A
  1. hospitalization
  2. supportive psychotherapy
  3. medical tx:
    a. antispychotics + mood stabilizers
    b. antidepressants or ECT (mood sxs)
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20
Q

tx of brief psychotic d/o (sxs for <1 month)

A
  1. brief hospitalization
  2. supportive psychotherapy
  3. course of antipsychotics for psychosis itself and/or benzos for agitation
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21
Q

tx for delusional d/o

A

very hard to tx; try psychotx + antipsychotics

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22
Q

tx for shared psychotic d/o

A
  1. separation
  2. psychotherapy
  3. antipsychotic medication if sxs have not resolved in 1-2 weeks after separation
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23
Q

tx of MDD

A
  1. hospitalization if @ risk for suicide, homicide, or is unable to care for self
  2. pharmacotherapy: SSRIs, TCAs, MAOIs
  3. adjunct meds: stimulants (methylphenidate) in terminally ill or pts w/ refractory sxs, antipsychotics in pts with psychotic features, TH?
  4. psychotherapy
  5. ECT
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24
Q

TCA s/e’s

A

prolonged QTC = lethal!

+ sedation, weight gain, orthostatic hypotension, anticholinergic effects

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25
Q

MAOI s/e’s

A
  • hypertensive crisis when used with sympathomimetics or tyramine-rich foods (wine, beer, aged cheese, liver, smoke meats)
  • serotonin syndrome when used in combo w/ SSRIs
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26
Q

MAOIs used to tx _____ depression

A

atypical (characterized by hypersomnia, hyperphagia, mood reactivity, leaden paralysis, hypersensitivity to interpersonal rejection)

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27
Q

Kubler-Ross model of grief

A
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
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28
Q

tx of bipolar d/o

A
  1. pharmacotherapy: lithium, anticonvulsants (carbamazepine, valproic acid), atypical antipsychotics
  2. psychotherapy
  3. ECT (works well in tx of manic episodes)
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29
Q

which drugs are especially good for treating rapid cycling bipolar (4+ episodes/yr) or mixed episodes (mania + depression)?

A

anticonvulsants (carbamazepine, valproic acid)

NB: associated with increased risk of suicide

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30
Q

tx of dysthymia

A
  1. cognitive therapy + insight-oriented psychotx

2. antidepressants in combo w/ psychotx

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31
Q

tx of cyclothymia

A

same antimanic agents as in bipolar: lithium, anticonvulsants (carbamazepine, valproic acid), atypical antipsychotics

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32
Q

tx of adjustment d/o (must begin w/in 3 months and end w/in 6 months of event)

A
  1. supportive psychotherapy (most effective)
  2. group therapy
  3. meds for associated sxs (insomnia, anxiety, depression)
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33
Q

tx of panic d/o

A
  1. SSRI, especially paroxetine/paxil or sertraline/zoloft (best long-term tx)
  2. other antidepressants (clomipramine, imipramine) may also be used
  3. benzos for short-term
  4. non-pharm: relaxation training, biofeedback, cognitive tx, insight-oriented psychotx

tx w/ meds for 8-12 months to prevent relapse

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34
Q

tx of specific phobias (e.g. animals, heights, blood/needles, illness/injury, death, flying)

A

pharmacotherapy NOT effective

  1. behavior therapy: systemic desensitization
    [2. if necessary: short course of benzos or beta blockers during desens to help control autonomic sxs]
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35
Q

tx of social phobia (e.g. speaking in public, eating in public, using public restrooms)

A
  1. paroxetine (paxil)
  2. beta blockers for autonomic sxs associated with performance anxiety
  3. CBT
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36
Q

tx of OCD

A
  1. SSRIs (first-line tx) or TCAs
  2. pharmacotherapy: exposure and response prevention (ERP)
    [3. last resort: ECT or surgery (cingulotomy)]
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37
Q

tx of PTSD or Acute Stress Disorder (<1 month)

A
  1. antidepressants: SSRIs, TCAs (imipramine, doxepin), MAOIs
  2. anticonvulsants for flashbacks or nightmares
  3. other: psychotherapy, relaxation training, support groups, family therapy, eye movement desensitization and reprocessing (EMDR)
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38
Q

tx of GAD

A
  1. psychotherapy (CBT)

2. pharmacotherapy: antidepressants (SSRIs, buspirone, venlafaxine/effexor) [+ SHORT-TERM benzos (clonazepam, diazepam)]

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39
Q

tx of personality disorders

A

very hard to tx

  • most useful: psychotherapy and group therapy
  • meds are only useful for coexisting sxs (depression, anxiety, etc)
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40
Q

tx of antisocial & borderline personality d/o

A

DBT

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41
Q

tx of narcissistic personality d/o

A

group therapy (to learn empathy)

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42
Q

tx of avoidant personality d/o

A
  1. psychotherapy (assertiveness training)

2. beta blockers for autonomic sxs of anxiety, SSRIs for major depression

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43
Q

common components of substance abuse/dependence tx

A
  1. behavioral counseling***
  2. psychosocial tx such as motivational intervention, CBT, contingency management, and individual | grp therapy
  3. 12-step programs
  4. pharmacotherapy if available
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44
Q

tx of alcohol intoxication

A
  1. monitor ABC’s, glucose, electrolytes, acid-base status
  2. give thiamine and folate
  3. head CT to r/o SDH or other brain injury
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45
Q

tx of alcohol withdrawal

A
  1. benzos (chlordiaxepoxide, diazepam, lorazepam/ativan) | anticonvulsants (carbamaz. or valproate)
  2. antipsychotics and temporary restraints for severe agitation
  3. “banana bag”: thiamine, folic acid, multivit
  4. correct electrolyte and fluid abnormalities (esp Mg2+ and K+)
  5. CIWA scale: monitor for signs and sxs of withdrawal
  6. Monitor for signs of hepatic failure
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46
Q

tx of alcohol dependence

A
  1. disulfiram/antabuse: blocks aldehyde dehydrogenase
  2. naltrexone/revia/IM-vivitrol: opioid receptor blocker
  3. acamprosate/campral: GABA analogue, ?inhibits glutamate
  4. topiramate/topamax: potentiates GABA and inhibits glutamate
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47
Q

tx of delirium tremens (DT)

A
  1. phenytoin/dilantin to prevent szs

2. benzos for sedation

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48
Q

which med should be used to tx alcohol dependence in pts w/ liver dz?

A

acamprosate

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49
Q

which med should be used to prevent EtOH relapse?

A

acamprosate

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50
Q

which meds reduce EtOH cravings?

A

naltrexone, topiramate

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51
Q

which med should be used to tx EtOH dependence in highly motivated pts?

A

disulfiram

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52
Q

tx of cocaine dependence

A

mainstay: psychological interventions (contingency, grp therapy, etc.)
- no FDA-approved pharmacotherapy

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53
Q

tx of amphetamine intoxication

A

rehydrate, correct electrolyte balance, tx hyperthermia

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54
Q

tx for opioid overdose

A

naloxone

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55
Q

tx for sedative intoxication

A

if ingestion was in last 4-6hrs: activated charcoal, gastric lavage to prevent further GI absorption
- for barbiturates only: alkalinize urine w/ sodium bicarb to promote renal excretion
- for benzos only: flumazenil
+ supportive care (respiration, BP)

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56
Q

tx of benzo withdrawal

A
  • benzo taper

- carbamazepine or valproic acid for sz prevention

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57
Q

tx of opioid withdrawal

A
  • for moderate sxs: clonidine (sympatholytic) for autonomic sxs, NSAIDs for pain, dicyclomine (anticholinergic) for abd cramps
  • for severe sxs: detox w/ buprenorphine or methadone
58
Q

psilocybin: street name & class

A

mushrooms (hallucinogen)

59
Q

mescaline: street name & class

A

peyote cactus (hallucinogen)

60
Q

lysergic acid diethylamide: street name & class

A

LSD (hallucinogen)

61
Q

tx of hallucinogen intoxication

A

monitor for dangerous behavior, reassure patient (physiologic effects are not life-threatening); use benzos or antipsychotics if necessary for agitation

62
Q

tx of MJ withdrawal

A

supportive and symptomatic

63
Q

tx of inhalants intoxication

A

monitor ABCs

64
Q

tx of nicotine dependence

A
  1. pharmacotherapy: varenicline (chantix) nicotinic receptor partial agonist, buproprion (zyban) nicotinic receptor partial agonist, nicotine replacement therapy
  2. behavioral counseling
65
Q

tx of delirium

A
  1. r/o medical causes –> tx if necessary
  2. supportive care: hydration and nutrition
  3. patient safety: CO, orientation, encourage normal day-night sleep cycle
  4. meds: haloperidol (first-line)

AVOID benzos, unless delirium is 2/2 EtOH or benzo withdrawal

66
Q

tx of Alzheimer’s Disease

A
  • no cure
    1. physical and emotional support, nutrition, exercise, supervision
    2. ACEi’s: tacrine (cognex), donepezil (aricept), rivastigmine (exelon), galantamine (razadyne)
    3. NMDA antagonists (memantine) for mod-severe dz
67
Q

tacrine (cognex)

A

ACEi (eg for tx of AD)

68
Q

donepezil (aricept)

A

ACEi (eg for tx of AD)

69
Q

rivastigmine (exelon)

A

ACEi (eg for tx of AD)

70
Q

galantamine (razadyne)

A

ACEi (eg for tx of AD)

71
Q

memantine (namenda)

A

NMDA antagonist (eg for tx of AD)

72
Q

tx of vascular dementia

A
  • no cure
    1. physical and emotional support, nutrition, exercise, supervision
    2. antihypertensives for prevention
    3. ACEi’s
    4. symptomatic tx
73
Q

tx of visual hallucinations in Lewy Body Dementia

A

cholinesterase inhibitors

74
Q

tx of visual decreased cognition, apathy, PMR in Lewy Body Dementia

A

psychostimulants, levodopa/carbidopa, dopamine agonists

75
Q

tx of REM sleep disorder in Lewy Body Dementia

A

clonazepam (klonopin)

76
Q

tx of frontotemporal dementia/Pick Dz

A

ACEi + antidepressants for behavioral sxs, but not cognition

77
Q

tx of HIV-associated Dementia (HAD)

A
  • HAART improves cognition and longevity

- psychostimulants target fatigue and PMR

78
Q

tx of Huntington Disease

A

supportive care

79
Q

tx for pseudodementia

A
  1. supportive psychotherapy
  2. community resources
  3. low-dose antidepressants (SSRIs > TCAs, nortriptyline | MAOIs)
  4. mirtazapine (remeron) for sleep or increased appetite
  5. methylphenidate (ritalin) for PMR, but can cause insomnia or arrhythmias
  6. ECT
80
Q

H2 blockers + EtOH = ???

A

higher BAL

81
Q

benzos, TCAs, narcotics, barbiturates, antihistamines + EtOH = ???

A

increased sedation

82
Q

ASA, NSAIDs + EtOH = ???

A

prolonged bleeding time, irritation of gastric lining

83
Q

metronidazole, sulfonamides, long-acting hypoglycemics + EtOH = ???

A

nausea and vomiting

84
Q

reserpine, nitroglycerin, hydralazine + EtOH = ???

A

increased risk of hypotension

85
Q

acetaminophen, isoniazid, phenylbutazone (NSAID) + EtOH = ???

A

increased hepatotoxicity

86
Q

antiHTNs, antiDMs, ulcer rx, gout rx + EtOH = ???

A

worsen underlying dz

87
Q

tx of behavioral sxs in elderly, demented pts

A
  1. nonpharm = PREFERRED: music, art, exercise, pet therapy, strict daily schedule, continual reorientation, reduced stimuli (quiet), surround pt with familiar objects
  2. pharm = if behaviors are potentially HARMFUL: antipsychotics
88
Q

treatment of oppositional defiant disorder (ODD)

A

psychotherapy focused on behavior modification and problem-solving skills

89
Q

treatment of conduct disorder

A
  1. tx w/ family and community involvement
  2. consistent rules and consequences
  3. adjunct meds if aggression + (antipsychotics, mood stabilizers, SSRIs)
90
Q

tx of ADHD

A

* first, tx any underlying mood d/o*

  1. first-line: CNS stimulants (methylphenidate, dextroamphetamine, and amphetamine salts)
  2. alpha-2 agonists (clonidine, guanfacine) if first-line tx can’t be used (s/e’s, refractory, etc.) or as adjuncts
91
Q

tx of Asperger d/o

A

supportive tx as with autism

92
Q

dx?

impaired cognitive development in girls age 5-48mo, MECP2, X-chromosome, sz’s, scoliosis, increased risk of sudden death

A

Rett disorder

93
Q

dx?

loss of previously acquired skills before age 10y; boys&raquo_space; girls; EEG abnl + sz d/o

A

childhood disintegrative disorder

94
Q

tx of tourette’s

A
  1. educational and supportive interventions
  2. supportive therapy and behavioral therapy
  3. pharm (if serious impairment develops):
    a. risperidone (atypicals) or clonidine/guanfacine (alpha-2 agonists)
    b. haloperidol, pimozide (typicals) in severe cases
    c. if comorbid OCD, tics respond well to SSRIs + antipsychotics
95
Q

tx of enuresis

A

high rates of spontaneous remission

  1. psychoedu, psychotx, family therapy, behavioral therapy
  2. behavior modification (bell-and-pad method), DDAVP (antidiuretic), imipramine (TCA)
96
Q

tx of encopresis

A

high rates of spontaneous remission

  1. psychoedu, psychotx, family therapy, behavioral therapy
  2. stool softeners if etiology = constipation (usually is)
97
Q

tx of selective mutism

A

psychotx, behavior tx, management of anxiety

98
Q

tx of separation anxiety d/o

A

family tx, CBT, and low-dose antidepressants

99
Q

tx of depersonalization disorder

A

antianxiety agents or SSRIs to tx associated sxs of anxiety or major depression

100
Q

tx of conversion d/o

A

** most pts spontaneously recover **

insight-oriented therapy, hypnosis, or relaxation therapy

101
Q

tx of hypochondriasis

A
  1. regularly scheduled visits to ONE pcp
  2. tx comorbid anxiety or depression (eg w/ ssri)
  3. CBT
102
Q

tx of body dysmorphic d/o

A

** do NOT do surg or derm procedure **

  1. SSRIs reduce sxs in 50% pts

[[gradual onset, may wax and wane]]

103
Q

define pain d/o

A

pain out of proportion with stimulus (even if real underlying medical d/o)

104
Q

tx of pain d/o

A

** analgesics are not helpful ***

SSRIs, biofeedback, hypnosis, psychotherapy

105
Q

dx?

intentional feigning of sxs for PRIMARY gain (emotional gain, attention, care, etc.)

A

factitious d/o

106
Q

dx?

intentional feigning of sxs for SECONDARY gain (drugs, money, avoidance of legal system, etc.)

A

malingering

107
Q

dx?

pts believe they are ill and do not intentionally produce or feign sxs, although there is no medical basis for sxs

A

somatoform d/o

108
Q

tx of intermittent explosive disorder

A

SSRIs, anticonvulsants, lithium, and propranolol

?grp and fam tx

109
Q

tx of kleptomania

A
  1. insight-oriented psychotherapy, behavior therapy such as systematic desensitization and aversive conditioning, and SSRIs
  2. anecdotal evidence for naltrexone use
110
Q

tx of pathologic gambling

A

** 1/3 achieve recovery w/o tx **

  1. participation in gambler’s anonymous = most effective tx
  2. after 3 months of abstinence, insight-oriented tx
  3. tx comorbid mood d/o’s, anxiety d/o’s, substance use problems w/ SSRIs, mood stabilizers, and opioid antagonists
111
Q

tx of trichotillomania

A
  1. meds: SSRIs, antipsychotics, or lithium

2. behavioral interventions: hypnosis, relaxation techniques, substituting another behavior, or positive reinforcement

112
Q

tx of pyromania

A

behavior therapy, supervision, SSRIs

113
Q

complications of refeeding syndrome

A

arrhythmias, respiratory failure, delirium, and seizures

114
Q

tx of anorexia nervosa

A
  1. food!!!
  2. behavioral therapy, family therapy, supervised weight-gain programs
  3. low-dose second-gen antipsychotics
  4. benzos before meals
115
Q

tx of bulimia nervosa

A
  1. antidepressants (SSRIs, esp fluoxetine) + therapy (CBT, interpersonal psychotherapy, grp or fam therapy)

** AVOID buproprion: lowers sz threshold **

116
Q

tx of binge eating d/o

A
  1. individual psychotherapy and behavioral therapy w/ strict diet and exercise program
  2. tx comorbid mood d/o’s
  3. weight-loss meds: stimulants (phentermine or amphetamine), orlistat (inhibits pancreatic lipase), sibutramine (inhibits reuptake or norepi, serotonin, dopamine)
117
Q

tx of primary insomnia

A
  1. sleep hygiene measures
  2. CBT
  3. pharm: benzos vs. non-benzos (zolpidem, eszopiclone, zaleplon) vs. antidepressants (trazodone, amitriptyline, doxepin)
118
Q

tx of obstructive sleep apnea (OSA)

A
  1. CPAP or BiPAP
  2. behavioral strategies such as weight loss and exercise
  3. surgery
119
Q

dx?

pathophys: loss of hypothalamic neurons that contain hypocretin (aka orexin)

A

narcolepsy

120
Q

tx of narcolepsy

A
  1. sleep hygiene
  2. scheduled daytime naps
  3. avoidance of shift work
  4. for excessive daytime sleepiness: amphetamine vs. non-amph. (methylphenidate, modafinil, sodium oxybate)
  5. for cataplexy: sodium oxybate (first-line), TCAs, SSRIs/SSNRIs
121
Q

tx of delayed sleep phase disorder

A
  • timed bright light phototherapy (dr. nagle) during early morning
  • melatonin at night
122
Q

tx of advanced sleep phase disorder

A
  • timed bright light phototherapy prior to bedtime
123
Q

shift-work disorder

A
  • avoid risk factors
  • bright light phototherapy to facilitate rapid adaptation to night shift
  • for severe cases: modafinil
124
Q

jet lag disorder

A
  • generally self-limited
125
Q

which part of the brain coordinates 24-hour or circadian rhythmicity?

A

suprachiasmic nucleus (SCN)

126
Q

tx for sleepwalking

A
  1. address precipitating factors (e.g. stress, hyperthyroidism, OSA, szs, migraines, etc.)
  2. ensure safe environment
  3. sleep hygiene

** if refractory, can tx w/ clonazepam, other benzos, or TCA **

127
Q

tx of sleep terrors

A
  1. reassurance: benign + self-lmtd
  2. in adults w/ refractory cases, consider low-dose, short-acting benzos (clonazepam, diazepam)
  3. sleep hygiene
  4. psychotherapy
128
Q

features distinguishing sleep terrors from nightmare d/o

A

sleep terrors: fall back asleep, amnestic in morning
vs.
nightmare d/o: awaken from sleep, no confusion or disorientation

129
Q

tx of nightmare d/o

A
  • imagery rehearsal therapy (IRT)

- in SEVERE cases, use antidepressants

130
Q

tx of dream enactment

A
  • clonazepam (effective in 90% pts)
  • – alternative meds: imipramine, carbamazepine, pramipexole (non-ergot DA agonist), or levodopa
  • ensure safety
131
Q

5 stages of sexual response cycle

A
  1. desire
  2. excitement
  3. plateau
  4. orgasm
  5. resolution
132
Q

medical conditions causing sexual dysfunction

A
  • atherosclerosis (vascular prob)
  • diabetes (neurogenic prob)
  • pelvic adhesions (pain)
  • depression
133
Q

drugs causing sexual dysfunction

A
  • antihypertensives
  • anticholinergics
  • antidepressants (SSRIs)
  • antipsychotics
  • substance abuse (long-term EtOH use, narcotics)
134
Q

street drugs that enhance libido

A

cocaine and amphetamines; short-term use of EtOH or MJ

135
Q

impact on libido: dopamine?

A

enhances

136
Q

impact on libido: serotonin?

A

inhibits

137
Q

tx of erectile dysfunction

A
  • phosphodiesterase-5 inhibitors (eg sildenafil, tadalafil)

- alprostadil (injection)

138
Q

tx of premature ejaculation

A
  • SSRIs or TCAs
139
Q

tx of hypoactive sexual desire disorder

A
  • testosterone for men with low levels
  • low-dose testosterone in women
  • estrogen-replacement for vaginal dryness and atrophy
140
Q

definition of frotteurism

A

sexual pleasure from touching or rubbing against a non-consenting person

141
Q

tx of paraphilias (pedophilia, frotteurism, voyeurism, exhibitionism, sadism, fetishism, transvetic fetishism, masochism, necrophilia, telephone scatalogia)

A
  • insight-oriented psychotherapy (most common method)
  • behavior therapy (aversive conditioning)
  • pharm: anti-androgens in men (reduces desire)

Psychiatry (1 decks)

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