Flashcards in Ethics/Radiology/Psychiatry Deck (59)
What is one exception to partial emancipation of minors to make their own medical decisions (e.g. sex, reproductive health, substance abuse)?
Abortion needs to be disclosed to parents in 36 states
If the parents of a child are Jehoviah's Witness can they deny life-saving therapy for their child?
Can a pregnant women refuse therapies which would assist the fetus while pregnant?
Yes. But once the fetus is out then she can't refuse life-sustaining treatment for it
To be useful a living will needs to be clear and precise
When is a court order an acceptable tool?
After all other options have been exhausted, including an ethics consultation
Is physician-assisted suicide and euthanasia ever the right answer (that is the intent to end life)?
Do you need the consent of the father for an abortion?
When can you break patient confidentiality?
When there is direct harm to others (e.g. physical harm in setting of psychiatric patient or communicable diseases like HIV)
Can physicians refuse to treat certain patients?
It is legal for them to do so but not always ethical
Lytic bone lesions may be caused by what cancer?
Primary bone cancer
Lung, renal, thyroid, or breast mets
Blastic bone lesions may be caused by what cancer?
Breast, prostate, or lymphoma mets
Medulloblastoma in peds
What is the preferred therapy for delusional disorders and personality disorders?
What are other tests which should be included your diagnostic work-up to rule out non-psych related diagnoses?
BMP (Calcium and other metabolic disorders)
Temporal lobe epilepsy hx
Besides psychosis, what are two other indications for the use of antipsychotics?
1) Sedating effect when BZDs contra-indicated
2) Huntington's Disease or Tourette's
Major side effect of clozapine
Agranulocytosis (Check a CBC once/week)
What are adverse effects seen with low-potency antipsychotics?
Orthostatic hypotension (from alpha blockade effect)
Dry mouth, urinary retention, blurry vision, delirium (anticholinergic effect)
Adverse effects of thioridazine
Prolongs QT and arrhythmias
Abnormal retinal pigmentation
What are adverse effects of some antipsychotics which are a major reason for male non-compliance?
Impotence and inhibition of ejaculation
What is the major advantage and disadvantage of use of typical high-potency antipsychotics (e.g. haloperidol and fluphenazine)?
Advantage: fewer side effects related to alpha blockade and anticholinergic effect; higher potency
Disadvantage: higher association with EPS symptoms
What is the major advantage and disadvantage of low-potency typical antipsychotics (e.g. thioridazine, chlorpromazine)?
Advantage: Less likely to cause EPS symptoms
Disadvantage: Greater sedating effect and risk of orthostatic hypotension and anticholinergic effects
What is the major benefit of atypical antipsychotics such as risperidone, quetiapine, olanzapine, and clozapiine?
Greater effect on negative symptoms and has less risk of EPS
Which antipsychotic has the greatest risk of weight gain?
How do you treat acute dystonic reactions or bradykinesia which occurs while on antipsychotics?
Anticholinergics (i.e. benztropine, diphenhydramine, trihexyphenidyl)
How do you manage akathisia which may result from antipsychotics?
BZD may help
Switch to a newer antispsychotic (e.g. risperidone)
How do you manage tardive dyskinesia?
Stop the old antipsychotic and start a new one
After discontinuing an old antipsychotic symptoms of tardive dyskinesia improve
Symptoms worsen first
What are non-antipsychotic meds which may also cause EPS symptoms?
Metoclopramide and prochlorperazine (antiemetics)
Mgmt of panic disorder
Cognitive behavioral therapy and relaxation training
SSRIs, BZD, imipramine, MAOI
Treatment of phobia disorders
BZD and Beta Blockers may be helpful when given prior to the exposure
Place these benzodiazepines in order of shortest to longest half-life:
What is a major benefit of buspirone compared to other anxiolytic effects?
No sedating effects
Major depressive disorder requires symptoms to last for how long?
In patients with newly diagnosed depression who are acutely suicidal what is an appropriate therapy?
ECT, which reduces risk of suicidality quicker than antidepressants would
Describe dysthymic disorder. What is mgmt?
Low level depression symptoms lasting 2 yrs
Individual psychotherapy is the best initial treatment, SSRIs can be used if that doesn't help
How is seasonal affective disorder managed?
Phototherapy and sleep deprivation
What is rapidly cycling bipolar disorder?
Greater than 4 manic episodes per year
How do you managed a bipolar patient who is well maintained on Li but becomes pregnant?
Use ECT in first trimester and Lamictal in 2nd and 3rd trimester
What is appropriate management of acute mania?
1) Mood stabilizing medicine to induce remission (e.g. Lithium)
2) Antipsychotic to control the acute mania (e.g. Risperidone)
3) IM Depot Phenothiazine in noncompliant and severely manic patients
What are second-line options for treatment of bipolar disorder?
Aripiprazole, quetiapine, olanzapine, divalproex
Describe cyclothymia and its mgmt
Recurrent episodes of depressed mood and hypomania over 2 years.
Psychotherapy is first and then if patients still need assistance may give Divalproex
What is appropriate treatment for a grief reaction?
What type of depression are MAOIs useful for?
How long should you keep a pt on an antidepressant before considering switching if it doesn't work?
Mirtazapine is a good antidepressant to use if patients have what additional symptoms to their depression?
Poor appetite, insomnia, weight loss
In which situations is trazodone a helpful antidepressant?
Patients with severe insomnia because of its sedating effect
What is the one SSRI not safe in pregnancy?
Which antidepressive medication should be avoided in patients with history of seizures?
What is the first line choice for rapidly cycling bipolar disorder?
What are serious side effects of carbamazepine?
Agranulocytosis and sedation
*CYP450 Inducer so increases clearance of warfarin, phenytoin, theophyllilne, valproic acid
What should you always discuss with a patient prior to starting an antidepressant medication?
If they have had suicidal ideations because some patients have increases thoughts of over the first 2 weeks
What medications assist with anorexia and bulimia?
Olanzapine (promotes weight gain)
What is appropriate treatment of body dysmorphic disorder?
How is intermittent explosive disorder managed?
Aggression out of proportion to stressor
Do you have to report spousal abuse?
No, its not indicated
Which is the one with weird thoughts and magical thinking, schizoid or schizotypal personality disorder?
What are characteristics of histrionic PD?
Exaggerated behaviors to draw attention to oneself, often through sexual means
What are characteristics of borderline PD?
Unstable affect with mood swings. Often can be suicidal and have chronic feelings of emptiness, identity disturbance, and inappropriate anger
What are potential treatments for opiate withdrawal?
Clonidine and/or methadone