Panre-Psychiatry/Behavior Science Flashcards

Question

Major depressive disorder (Level 2) s/s? Sig Em Caps

Answer 1

SIG EM CAPS S leep insomnia or hypersomnia ○ I nterest (↓ interest or pleasure in activities) ○ G uilt (thoughts of worthlessness or inappropriate guilt) ○ E nergy ↓, fatigue ○ M ood ↓ ○ C oncentration ↓ ○ A ppetite and weight ↓ or ↑ ○ P sychomotor agitation or retardation ○ S uicidal ideation (recurrent thoughts of death) Symptoms must not be due to substance use, medical issues or bereavement ● Symptoms must cause distress/impairment in daily functioning ● Absence of mania or hypomania

Answer 2

Female 2x> Male, highest incidence 20-40s, FH ○ 15% commit suicide, ↑ suicide rates: White males > 45y, detailed plan, substance abuse

Answer 3

Psychotherapy - 1st line in mild/moderate depression, cognitive behavioral therapy (CBT) ○ SSRIs- 1st line for medicine; also SNRIs, TCAs, MAOIs; minimum 3-6 weeks ○ Electroconvulsive therapy (ECT) for pts who fail medical therapy; transcranial magnetic stimulation (TMS)

Answer 4

Gambling disorder is the only DSM-5 recognized disorder ● Other behavioral addictions include pornography, sex, social media, video gaming, shopping, food, exercise ● Screen for maladaptive behaviors similar to substance use disorder but there is currently no specific diagnostic criteria except for gambling disorder ○ DSM 5 says “behavioral addictions...are not included because at this time there is insufficient peer-reviewed evidence to establish the diagnostic criteria…”

Answer 5

Behavior leading to clinically significant impairment/distress with 4+ sx in 1 year *Extrapolate these diagnostic criteria to other behavioral addictions, replace specific behavior for gamble/gambling* ○ Need to increased amount/time *gambling* to achieve same excitement ○ Restless/irritable when attempting to cut down/abstain ○ Unsuccessful attempts to cut back/stop ○ Preoccupied by *gambling* ○ *Gambles* when distressed ○ Gambles even after losing money (“chasing losses”) ○ Lies about extent of *gambling* ○ Jeopardized or lost significant life relationship/job due to *gambling* ○ Relies on others for money to relieve financial stress caused by gambling

Answer 6

Dx: Recurrent, unexpected panic attacks (abrupt onset, peak within 10 min, duration <60 min) with ○ At least 2 with one of the following for at least 1 mo ■ Panic attack followed by concern for future attack ■ Worry about implication of attack ■ Significant change in behavior d/t attack ○ At least 4 symptoms of panic attack ■ Tachypnea, chest pain, palpitations, diaphoresis, nausea, trembling, dizziness, fear of dying/doom ○ Sxs not due to substance use, medical or other psychiatric condition ○ ± Agoraphobi

Answer 7

2x more women>men, average age of onset is 25y

Answer 8

Angina, MI, arrhythmias, hyperthyroidism, pheochromocytoma, | substance-induced anxiety, generalized anxiety disorder (GAD), PTSD

Answer 9

Perioral and/or acral paresthesias from hyperventilation (fairly specific to panic attacks)

Answer 10

Short-term: Benzodiazepines, hydroxyzine ○ Long-term: Psychotherapy, cognitive behavioral therapy (CBT), medications- SSRI

Answer 11

Clinically significant stress/impairment in daily interactions due to exposure to a life-threatening traumatic event either by: Direct experience of event ○ Witnessing event ○ Learning event happened to someone close ○ Occupational extreme or repeated exposure to details of event; Common traumatic events: Sexual assault, combat experiences, childhood abuse

Answer 12

Presence of ≥ 1 of the following symptoms for > 1 mo: ○ Intrusion - reexperiencing event through nightmares, flashback, intrusive thoughts ○ Avoidance of stimuli related to the event ○ Negative alterations in mood/cognitions- numbed responsiveness, detachment, guilt, self-blame ○ Changes in arousal and reactivity- ↑ arousal, hypervigilance, exaggerated startle, sleep disturbances, irritability, ↓ concentration

Answer 13

SSRI, trazodone may help insomnia, CBT

Answer 14

Maladaptive pattern of substance use that leads to clinically significant impairment ○ Can be applied to most substances (not caffeine

Answer 15

2 of 11 criteria within 1 year Impaired control ■ 1. Consumption of greater amounts than intended ■ 2. Failed attempts to cut down/abstain ■ 3. Increased amount of time spent using/acquiring/recovering ■ 4. Craving ○ Social impairment ■ 5. Failure to fulfill responsibility at work/school/home ■ 6. Continued use despite recurrent social/interpersonal issues 2º to substance ■ 7. Isolation from life activities ○ Risky use ■ 8. Use in physically hazardous situation ■ 9. Continued use despite recurrent physical/psychological issues 2º to substance ○ Pharmacologic ■ 10. Tolerance and need for progressively larger amounts for same effect ■ 11. Withdrawal symptoms when not using substance

Answer 16

✔ urine and blood tox, LFTs, ETOH

Answer 17

Risks: Men 4x>women, FH ● Dx: CAGE questions ○ Have you ever felt the need to CUT down on your drinking? ○ Have you ever felt ANNOYED by criticism of your drinking? ○ Have you ever felt GUILT about your drinking? ○ Have you ever had to take an morning EYE opener?

Answer 18

Tremor, tachycardia, delirium tremens (DTs), seizures, agitation, hallucinations, potentially fatal Timeline after last drink ■ 6-24 hours: Uncomplicated sxs → tremor, anxiety, diaphoresis ■ 6-48 hours: Withdrawal seizure ■ 12-48 hours: Hallucinations with normal vitals and clear sensorium ■ 2-5 days: Delirium tremens → altered sensorium, abnormal vital signs(associated with mortality rate of up to 5%) Withdrawal seizures: Generalized tonic-clonic, begin within 12-48 hour after the last drink, often in chronic alcoholics, age 40-50 y/o All puts with DTS required admission and IV benzos

Answer 19

Benzo taper, multivitamin + folic acid, thiamine to prevent | Wernicke encephalopathy; Pts with hx of complicated withdrawal can be prophylactically tx with oral chlordiazepoxide

Answer 20

Disulfiram, naltrexone, group therapy/alcoholics anonymous

Answer 21

GI bleeding d/t ulcers, varices, Mallory-Weiss tears, pancreatitis, liver disease

Answer 22

Risk factor for major pulmonary, cardiac and cancer deaths ● Withdrawal sx: Anxiety, craving, irritability, sleep changes ● Tx: Nicotine tapering therapy ± bupropion, varenicline

Answer 23

Intoxication s/s: Euphoria and sedation, pupillary constriction, respiratory depression, bradycardia, hypotension, N/V, flushing, constipation ● Withdrawal s/s: “Hurts all over”, non life-threatening (no seizures), lacrimation, hypertension, pupillary dilation, piloerections, sweating, diarrhea, tachycardia

Answer 24

Acute intoxication: Naloxone, onset ~ 2 min IV, ~ 5 min IM ○ Withdrawal: Symptom control with clonidine, loperamide, NSAIDs, buprenorphine + naloxone Long term management: Methadone, suboxone

Answer 25

#1 predictive factor: previous attempt or threat ● Always ask patients if they have a plan, access to firearms Other risk factors: Underlying psychiatric disorders, substance abuse, family history

Answer 26

``` Suicide attempts: Female > Male ○ Suicide completions: Male > Female ○ Suicide rate ↑ with age ■ #1 elderly white males ○ White > Black ○ Alone > never married > widowed > separated/divorced > married without kids > married with kids ```

Answer 27

Medical stabilization, reduction of immediate risk, safety planning, managing underlying psychiatric illness and factors, monitoring and follow up

Answer 28

↓ ability to regulate sleep-wake cycles

Answer 29

→ mins), cataplexy (emotionally-triggered transient muscle weakness), sleep paralysis &/or hallucinations when falling asleep or awakening; usually sleep about the same number of hours at night as most people, but have interrupted sleep

Answer 30

clinical; polysomnography (REM occurs at sleep onset)

Answer 31

lifestyle changes (daytime naps); CNS stimulants (eg. modafinil, methylphenidate

Answer 32

Disruptive sleep disorders that occur during arousals from non-rapid eye movement (NREM) or rapid eye movement (REM) sleep – can occur while falling asleep, sleeping or waking up

Answer 33

often run in families & usually occur in children or adolescents; pts usually return to sleep & are amnestic to events in the morning – most pts outgrow these conditions by young adulthood

Answer 34

usually involve dream enactment & pts usually recall the dream and associated actions – these conditions most often occur late in adult life & are associated with degenerative brain dz

Answer 35

clinical; polysomnography for REM sleep behavior disorder

Answer 36

Sleep hygiene o Avoiding substance use o Injury protection (sleeping close to floor level, removing surrounding sharp objects) o Possibly benzodiazepines (eg. clonazepam) to promote sleep depth & continuity; also, melatonin o Sleep medicine consult

Answer 37

Somnambulism (sleep walking); Sleep (night) terrors:

Answer 38

NREM, Sleep walking; Sitting, moving around or walking with eyes wide open, but actually still in deep NREM sleep – may wake up during an episode & appear confused, or get back into bed without waking; most people do not recall the event

Answer 39

NREM; Abrupt arousal in a state of terror often screaming, crying or flailing, ↑ heart & respiratory rates, sweating, skin flushing – pt may appear to be awake, but is confused and unable to communicate normally; most people do not recall the event

Answer 40

REM sleep behavior disorder; Nightmares:

Answer 41

Vocalization (sometimes profane) & often aggressive movements (punching, kicking) that reflect physical acting out of dreams; pts usually recall vivid dreams upon awakening

Answer 42

Abrupt arousal in a state of fear, terror and/or anxiety brought about by vivid dreams during sleep; pts can usually describe detailed dream content – usually due to illness, anxiety or traumatic event

Answer 43

Highly selective for blocking serotonin reuptake at neuronal membrane

Answer 44

``` Citalopram Escitalopram Fluvoxamine Fluoxetine Paroxetine Sertraline ```

Answer 45

``` #1 for depression & anxiety • Obsessive compulsive disorder (OCD) • Bulimia nervosa • Premenstrual dysphoric disorder (PMDD) ```

Answer 46

``` GI upset • Sexual dysfunction • Headache Insomnia • Anxiety • Weight changes Serotonin syndrome especially if used with MAOI → ```

Answer 47

``` especially if used with MAOI → Acute altered mental status • Coma • Restlessness • Diaphoresis • Tremor • Hyperthermia • N/V • Abdominal pain • Tachycardia ```

Answer 48

``` Avoid citalopram in patients with long QT syndrome • Avoid paroxetine in pregnancy (can cause pulmonary HTN) ```

Answer 49

``` Benefits: • Preferred for children • Easy dosing • Less side effects • Low toxicity in overdose ```

Answer 50

Desvenlafaxine Duloxetine Venlafaxine

Answer 51

Inhibits serotonin, norepinephrine & dopamine reuptake

Answer 52

#1 for depression with significant fatigue or pain syndromes • 2nd line to SSRI

Answer 53

Similar to SSRI + hyponatremia & noradrenergic symptoms

Answer 54

``` Cautions: • MAOI • Renal/hepatic impairment • Seizures • HTN ```

Answer 55

``` Avoid abrupt discontinuation • ↑ serotonin syndrome risk when used with St John’s Wort ```

Answer 56

``` Amitriptyline Clomipramine Desipramine Doxepin Imipramine Nortriptyline ```

Answer 57

nhibits presynaptic reuptake of serotonin & norepinephrine

Answer 58

``` Depression • Insomnia • Diabetic neuropathic pain • Post-herpetic neuralgia • Migraine • Urge incontinence • Enuresis (imipramine) ```

Answer 59

``` Anticholinergic effects (dry mouth, constipation, urinary retention, sedation) • Weight gain • Prolonged QT interval • Overdose: Na⁺channel blocker effects, wide complex tachycardia (correct with bicarbonate), ARDS, SIADH ```

Answer 60

``` MAOI • Recent MI • Hx of seizure • Check ECG before starting to r/o AV blocks Contraindications: • Pregnancy ```

Answer 61

``` • Used less often due to SE & severe overdose toxicity • Non-depressed patients feel sleepy • Depressed patients have mood elevation ```

Answer 62

Tetracyclic compounds; Enhances central noradrenergic & serotonergic activity

Answer 63

Depression

Answer 64

``` Sedation • Dry mouth • Constipation • Weight gain • Agranulocytosis ```

Answer 65

Caution with MAOI

Answer 66

Less sexual dysfunction

Answer 67

Phenelzine

Answer 68

Refractory depression

Answer 69

``` Insomnia • Anxiety • Orthostatic hypotension • Weight gain • Sexual dysfunction • Hypertensive urgency/ emergency (with tyramine containing foods) ```

Answer 70

Caution + SSRI → serotonin syndrome • Caution + TCA → delirium & HTN

Answer 71

Avoid tyramine containing foods - aged/fermented cheese, wine, beer, smoked meats

Answer 72

Atypical ; Inhibits neuronal uptake of | dopamine

Answer 73

``` Depression • Smoking cessation • Attention-deficit hyperactivity disorder (ADHD) • Seasonal affective disorder (SAD ```

Answer 74

``` ↓ seizure threshold • Agitation • Anxiety • Restlessness • Weight loss • HTN • Headache • Dry mouth ```

Answer 75

``` Cautions: • Seizure disorder • Eating disorder • MAOI use • Drug/ETOH detoxification ```

Answer 76

• Less sexual dysfunction & GI distress than SSRI • Avoid abrupt withdrawal

Answer 77

Atypical; Serotonin antagonist & reuptake inhibitor

Answer 78

Depression • Anxiety • Insomnia

Answer 79

Sedation | • Priapism

Answer 80

Butyrophenones | Phenothiazines

Answer 81

Typical 1st Generation ; Droperidol Haloperidol; Blocks CNS D2 receptors • Dopamine antagonist

Answer 82

``` Psychosis • Schizophrenia (especially positive symptoms) • Tourette syndrome • Alcoholic hallucinosis • Antiemetic ```

Answer 83

``` • Extrapyramidal symptoms (EPS) • QT prolongation • Weight gain • ↑ prolactin • Sedation ```

Answer 84

Liver disease • Haloperidol CI with Parkinson disease • Anticoagulant use

Answer 85

``` IM Depot Preparations for non-compliant patients • Haloperidol q 4 wks • Fluphenazine q 2 wks ```

Answer 86

``` Chlorpromazine Fluphenazine Thioridazine; Blocks CNS D2 & 5HT2 receptors • Dopamine antagonist ```

Answer 87

Psychosis • Schizophrenia • Chlorpromazine for intractable hiccups

Answer 88

``` EPS • QT prolongation • Weight gain • ↑ prolactin • Sedation • Thioridazine can cause irreversible retinitis pigmentosa ```

Answer 89

• Liver disease

Answer 90

Lithium Carbamazepine Lamotrigine Valproic acid

Answer 91

``` • Alters cation transport across cell membrane • Influences reuptake of serotonin and/or norepinephrine;• # 1 mood stabilizer especially in suicidal patients • Management of bipolar disorder (BPD) • Acute mania in BPD • Last drug of choice for SIADH; Lithium induced diabetes insipidus: treat with amiloride • Fine tremor: treat with propranolol • Hypothyroidism • N/V • Leukocytosis • Cardiac arrhythmias • Toxicity: ataxia, dysarthria, delirium, acute renal failure; • ↓ renal function • Pregnancy; • ↓ suicide risk • Narrow therapeutic window so must monitor blood levels • Toxicity >1.5 mEq/L ```

Answer 92

``` Stabilizes electrical activity in the brain; • 2nd line mood stabilizer • Anticonvulsant • Trigeminal neuralgia; • Hyponatremia • Diplopia • Ataxia • Aplastic anemia • Agranulocytosis: monitor CBC; Cautions: • Gout • DM 2 ```

Answer 93

``` Stabilizes electrical activity in the brain ; • 2nd line mood stabilizer • Anticonvulsant ; • Rash/SJS • Visual disturbance; ↑ dose slowly & monitor for rash ```

Answer 94

``` Stabilizes electrical activity in the brain; • BPD • Anticonvulsant; • Pancreatitis • Hepatotoxicity • GI upset; • Pregnancy • Hepatic disease ```

Answer 95

Chronic pain, Diabetic neuropathic pain • Post-herpetic neuralgia •

Answer 96

Bedwetting

Panre-Psychiatry/Behavior Science Flashcards

(124 cards)