Psych Flashcards
(125 cards)
1
Q
What is Panic Disorder?
A
Presentation: Recurrent and unexpected panic attacks w/ >=4 of the following: chest pain, palpitations, SOB, choking; trembling, sweating, nausea, chills; dizziness, paresthesias; derealization, depersonalization; fear of losing control or dying
Worrying about additional attacks, avoidance behavior
Tx: 1st line/maintenance: SSRI/SNRI or CBT
Acute distress: benzodiazepines
Pt frequently develop agoraphobia, which is anxiety + avoidance >= 2 situations in which it may be difficult to escape or get help in event of panic attack.
Panic + agoraphobia - CBT + SSRI = 1st line treatment
2
Q
What is the assoc. b/n psych drugs and Parkinson’s?
A
Dopamine precursors (eg levodopa) and dopamine agonists (eg pramipexole) are assoc. w/ psychosis Tx: dose reduction for carbidopa-levodopa
3
Q
Schizophrenia
A
Assoc. w/ lateral ventricular enlargement,
decreased volume of the hippocampus and amygdala
4
Q
What is acute intemittent porphyria?
A
A hereditary disorder involving alteration in heme biosynthesis
Presentation: abdominal pain + new-onset neuropysch sxs
Dx: urinary porphobilinogen
5
Q
What drugs can increase Li concentration?
A
ACE-i, tetracyclines, metronidazole, NSAIDs, thiazide diuretics.
6
Q
What is reactive attachment disorder?
A
Characterized by a pattern of emotional and social withdrawal as well as a lack of positive repsonse to attempts to comfort.
May develop in young children who are abused, neglected, or institutionalized
7
Q
What is venlafaxine?
A
An SNRI assoc. w/ dose-dependent hypertension. At high doses, it inhibits NE with effect of increasing systolic and diastolic blood pressure.
8
Q
What is first line maintenance treatment for bipolar disorder?
A
Li, valproate, quetiapine, and lamotrigine.
Li reduces risk of suicide.
Li contraindicated w/ renal insufficiency.
Valproate contraindicated w/ liver dysfunction/ is hepatotoxic.
Severe illness: Li or Val + 2nd generation antipsychotic (quetiapine)
Antidepressant monotherapy should be avoided in maintenance treatment of bipolar 1 disorder due to risk of mood destabilization (eg induction of mania or a mixed state)
If antidepressant is used to treat an acute depessive episode, it should be slowly tapered and discontinued during maintenance treatment.
9
Q
What is the tx for PCP intoxication?
A
Benzos; diazepam, lorazepam (parenteral formulation)
Haloperidol is 2nd line, contraindicated in seizure disorders
Propofol is 3rd line
10
Q
Bulimia nervosa and electrolyte abnormalities.
A
Due to vomiting: metabolic alkalosis w/ hypokalemia (due to renal losses of K in setting of alkalosis) and hypochloremia.
Hypokalemia in otherwise healthy young adult is concerning for covert BN.
11
Q
Antidepressant discontinuation syndrome.
A
Abrupt discontinuation or rapid taper of short 1/2life SSRIs results in psychological and physical symptoms of antidepressant discontinuation syndrome.
Tx: restarting the medication followed by gradual taper
12
Q
What is buspirone?
A
An anxiolytic used to treat generalized anxiety disorder.
Not effect in mgmt of acute anxiety, not used to treat panic disorder
13
Q
What is the pathophysiology of tardive dyskinesia?
A
Gradual in onset
Dopamine D2 upregulation and supersensitivty resulting from chronic blockade of dopamine receptors.
Tx: reduce antipsychotic dose; use valbenazine or deutetrabenazine (reversible inhibitors of VMAT2); switch to quetipaine or clozapine (clozapine good for pts w/ hx of poor response to multiple antipsychotics)
14
Q
What is sedative hynotic overdose?
A
Benzo overdose: AMS, ataxia, slurred speech; arousable and have normal vital signs
Benzos + alcohol overdose: bradycardia, hypotension, respiratory depression, hyporeflexia
15
Q
What is electroconvulsive therapy?
A
First-line; used to treat major depressive disorder w/ psychotic features in depressed elderly pts who are unable to eat + drink, are psychotic, or actively suicidal
Achieves a rapid response: induces 30-60s generalized tonic clonic seizure
Non-emergent tx for MDD w/ psychotic features: antidepressant + antipsychotic
Antidepressants typically take 6-8w for response and must be combined w/ an antipsychotic med to effectively treat MD w/ psychotic features.
16
Q
What is methamphetamine use disorder?
A
Presentation: aggressive behavior, paranoid delusions, auditory, visual and tactile hallucinations (bugs crawling under skin); marked wt loss, severe tooth decay (“meth mouht”), and excoriations due to skin picking
17
Q
What is cocaine withdrawal?
A
Follows uprupt sensation (“crash”)
Can cause acute depression w/ suicidal ideation
Presentation: depression, fatigue, hypersomnia, increased dreaming, hyperphagia, impaired concentration, intense drug craving
18
Q
Treatment for alcohol withdrawal.
A
In pts w/ liver disease: Lorazepam, Oxazepam, and Temazepam (LOT) due to shorter 1/2Lives and lack of active hepatic metabolites.
Lorazepam can be given IM
Chloridazepoxide + Diazepam have long 1/2Lives and active metabolites that risk buildup and toxicity in pts w/ liver dysfunction.
19
Q
Dementia w/ lewy body treatment.
A
Pts are extremelly sensitive to antipyschotics
Use of risperidone assoc. w/ worsening confusion, parkinsonism (rigidity), and autonomic dysfunction
Preferred: low potency SGA (quetiapine)
FGA (haloperidol) should be avoided entirely
20
Q
Cabidopa/Levodopa
A
May produce orthostatic hypotension and confusion.
21
Q
Akathisia.
A
Should be consdered if pt’s psychosis worsens clinically when antipsychotic dosage is increased.
Tx: antipsychotic dosage reduction, propranolol (1st line), benztropine, or a benzodiazepine
22
Q
Cough medication + hallucinations.
A
Antihistamines (diphenhydramine, doxylamine): confusion + hallucinations
Phenylephrine: agitation, psychosis
Dextromethorphan (NMDA antagonist): dissociative sxs + hallucinations
23
Q
ADHD treatment.
A
Stimulants (methylphenidate, amphetamines) are first line.
Non-stimulants (atomoxetine, NE reuptake inhibitor) - family preference for nonstimulant or in pts w/ substance use disorders; clonidine, guanfacine (alpha 2 adrenergic agonists) - following adverse effects or lack of response from stimulants or atomoxetine
24
Q
MDMA (ecstasy)
A
A synthethic amphetamine w/ mild hallucinogenic properties; causes an increase in synpatic NE, D, and SE; neurotoxicity may develop w/ long-term use
Increases sociabilty, empathy, sexual desire
Intoxication:
-amphetamine toxicity: HTN, tachycardia, hyperthermia
-SE toxicity: SE syndrome (autonomic dysregulation, high fever, AMA, neuromuscular irritability, seizures) + hyponatremia (due to drug-induced inappropriate ADH secreation as well as excessive water intake to reduce hyperthermia)
25
Bath salts.
Amphetamine analog that can also cause SE syndrome.
However, they are more likely to cause AGITATION, COMBATIVENESS, and acute PSYCHOSIS and are less likely to be assoc. w/ hyponatremia.
Not detectable on routine tox screens
26
Benztropine.
Can atreat drug-induced parkinsonism (eg gradual onset tremor, rigidity, bradykinesia) and acute dystonia )muscle spasms/stiffness, torticollis, opisthotonus, oculogyric crisis).
Not shown to improve abnormal movements of TD (anticholinergics may worsen them.)
27
Diphenhydramine.
An antihistamine w/ strong anticholinergic properties can also be used to treat dystonias (sudden in onset, muscle spams or stiffness in the head and neck).
Not shown to improve abnormal movements of TD (anticholinergics may worsen them.)
Benztropine can be used as well (anticholinergic)
28
Lorazepam + Delirium.
Lorazepam + other benzos may be used to treat agitation in young pts.
They are typically contraindicated in older pts, who are at increased risk for adverse events (eg withdrawl, dependence, motor impairment), may experience worsening agitation (paradoxic effect), and tend to metabolize benzos slowly, making their effects very long-lasting.
29
Imaginary friends.
Having an imaginary friend is most common in children age 3-6, but can be seen throughout school-age years.
30
What are the side effects of SSRIs?
Early: headache, nausea, insomnia
| Long-term: sexual dysfunction, weight gain
31
What is delayed sleep-wake phase disorder?
A circadium rhythm disorder characterized by the inability to fall asleep at traditional bedtimes, resulting in sleep-onset insomnia and excessive daytime sleepiness.
Commonly described as "night owls" and have chronic problems going to sleep at a conventional time (typically, prior to midnight)
Pts sleep normally if allowed to follow their internal rhythm and sleep until late morning.
32
What is advanced sleep-wake phase disorder?
A circadian rhythm disorder characterized by the inability to stay awake in the evening (usually after 7pm) and by early morning insomnia.
33
What is shift work disorder?
Involves a recurrent pattern of sleep interruption due to shift work, causing difficulty in initiating and maintaing sleep and producing daytime sleepiness.
Due to a work schedule that is incongruent w/ a normal circadian clock (a pt w/ a normal circadian rhythm who is required to work the night shift).
34
Antidepressant treatment timeline.
To decrease risk of depressive relapse continue antidepressant treatment at the same dose remission was achieved for an additional 6mo in pts w/ single-episode, unipolar major depression. If complete remission is maintained at the end of continuation phase, the antidepressant can be gradually tapered and discontinued.
Maintenance phase treatment: continuing antidepressant medication past initial continuation phase tx; maintenance for 1-3y is approp. for pts w/ a high risk of recurrence.
Pts w/ a hx of highly recurrent MDD, chronic episodes, strong fhx, or severe episodes (suicide attempt) should continue maintainence tx indefinitely.
35
Mgmt of acute agitation.
Benzo (IM) and/or an antipsychotic agent (FGA or SGA)
| Lorazepam is often used due to its rapid onset of action and IM formation.
36
Depression in adolescents.
Depressed adolescents may be irritable rather than sad.
If a pt displays irritability along w/ social w/drawal and academic decline, major depression should be considered.
Tx: pyschotherapy; severe cases - antidepressants (fluoxetine)
37
Depression in older adults.
Initially present with focus on somatic complaints than on subjective changes in mood and interest.
38
Autism spectrum disorder.
Speech delay, social isolation, repetitive stereotypical movements (head banging) fixed interest in objects
Lack of interest in shared social play and impaired joint attention (eg lack of pointing or bringing objects to others) are characterisitic
Odd repetitive behaviors, rigid adherenece to routines
Can occur w/ and w/o language and intellectual impairment
Language deficits range from complete lack of speech to language delalys and odd, stilted speech
Language delay w/o attempt to compensate through nonverbal means of communication is characteristic
Preference for solitary play, lack of eye contact, poor response to name when called
39
Oppositional definant disorder.
Presents w/ irritable or angry mood, argumentativeness or deliberatly annoying behavior, and vindictiveness toward authority figures.
Temperamental, hostile, and defiantly break rules.
40
Conduct disorder.
Rights of others or societal norms are purposefully violated (aggression, stealing, destroying property, assaulting others)
41
Disruptive mood dysregulation disorder.
Temper outburts that are out of proportion to the stimulus and inconsistent w/ developmental age.
Sxs manifest prior to age 10.
42
What is stranger anxiety?
Normal part of early child developement, starts at 6mo peaks at 8-9mo, generally resolves by 2 years
Children cry when an unfamilar person approaches even in presene of mother
43
What is separation anxiety?
Part of normal development, resolves when child develops object permanence typically age 18-24mo
44
What is adjustment disorder?
Emtional or behavior sxs (anxiety,d epression, disturbance of conduct) developing w/in 3 mo of an identifiable stressor and lasting no longer than 6mo once the stressor ceases.
Sxs are distressing and impairing but do not meet criteria for another mental disorder.
45
What is generalized anxiety disorder?
Characterized by excessive, uncontrollable worry about MULTIPLE issues (eg school, family, finances, health) for >=6mo.
Typically worry about minor matters and have a chronic course.
Insomnia, fatigue, physical symptoms related to muscular tension (headaches, neck, shoulder, and back pain)
Other physical manifestation: trembling, sweating, GI sxs
46
What is cocaine use disorder?
Mood swings, erratic behavior due to sympathetic NS stimulation (tachycardia, pupil dilation, diaphoresis, tremors)
Anxiety, irritability, mood swings, panic attacks, grandiosity, impaired judgement, psych sxs (paranoia, hallucinations) that resemble an acute manic episode
Paranoid and grandiose delusions and auditory, visual, or tactile hallucination may occur.
Increased energy, wt loss, erythema of the nasal mucosa (in those who snort cocaine)
Withdrawal: depression and lethargy
47
SGAs
Serotonin 2A and dopamine D2 antagonists.
| Added SE receptor binding of SGAs reduces likelihood of extrapyramidal side effects.
48
Mirtazapine
Preferred for depressed patient with poor sleep and appetite
| First line depressant medication whose side effects include stimulation of appetite, wt gain, and somnolence
49
Bipolar I disorder treatment.
Highly recurrent illness that requires long-term maintenance tx to decrease risk of recurrent mood episodes.
Clinically effective medication should be continued unless signifiant side effects or contraindications prohibit use.
50
Bupropion
First line treatment for adult MDD and less potential to cause weight gain.
Lacks evidence in pediatric depression and is not 1st line in this age group.
51
Fluoxetine
Considered first line medication for pediatric MDD. Among the SSRIs, has the least potential to cause wt gain.
52
MDD + psychotic features
Depressive episode is accompanied by delusions and/or hallucination, typically depressive themes (deserving punishment, worthlessness, nihilism)
Pyschotic symptoms only occur during the major depressive episode
Tx: combo pharmacotheapy w/ an antidepressant and antipyschotic or electroconvulsive therapy
53
Illness anxiety disorder
Excessively concerned about having a serious, undiagnosed general medical condition.
Pts fear having a specific illness but have minimal or no physical symptoms; they are primarily concerned w/ the idea that they have an illness.
54
Somatic symptom disorder
Excessive anxiety and thoughts about the seriousness of >=1 somatic symptoms for >=6 months.
Genuinely suffering and not trying to be deceptive.
Dx when significant somatic symptoms are present
Mgmt: regularly schedule visits, avoiding unnecessary diagnostic testing and specialist referrals
Tx: SSRIs are first line (fluoxetine)
55
Persistent complex bereavement disorder/complicated grief
Commonly have depressive symptoms, but theri sadness centers on the loss of a loved one and is characterized by intense yearning for the deceased
56
What is schizoaffective disorder?
Must be evidence of psychotic symptoms for >=2weeks in absence of mood episode.
57
Alcohol use.
Tx: Naltrexone is a 1st line pharmacotherapy for alcohol use disorder that decreases cravings and heavy drinking. It can be initiated in opioid-free pts w/o signficant liver disease who are still drinking.
Acamprosate is primarily used to maintain abstinence, should be avoided in pts w/ significant renal impairment
58
What is disulfiram?
An aldehyde dehydrogenase inhibitor
Aversive agent that causes unpleasant physiologic reacton when alcohol is consumed
Can only be used in abstinent pts
Good second line agent
59
Social anxiety disorder
Characterized by anxiety and fear of scrutiny in social situation, resulting in avoidance, distress, and social-occupational dysfunction.
Fear is of social humiliation and criticism and they do not experiences spontaneous panic attacks.
Tx: SSRI or SNRI
CBT can also be used as a first line nonpharmacological treatment
60
What is catatonia?
Immobility, waxy flexibility, and mutism
Tx: benzo (lorazepam) and/or electroconvulsive therapy
Lorazepam challenge test (IV lorazepam 1-2mg) resulting in partial, temporary relief w/in 5-10min confirms the dx
Catatonia generally responds to lorazepam w/in a week. ECT is TOC in pts who do not improve.
61
What is psychodynamic therapy?
Focuses on unconscious conflicts and developing insight.
62
Anorexia
BMI <18.5
Intense fear of gaining wt and distorted body image despite significant low weight
First line treatment: weight restoration through nutritional rehabilitation and psychotherapy. CBT is most effective.
Antidepressants are reserved for pts w/ AN who have severe comorbid depression or anxiety that persitsts despite wt restoration.
Fluoxetine is effective in bulima nervosa.
63
Antidepressants + BP
All antidepressants carry risk of inducing mania in susceptible patients, and many patients who experience this are ultimately diagnosed w/ a BP spectrum disorder.
If manic symptoms persist despite discontinuring the antidepressant, treatment w/ a mood stabilizer (eg Li, valproate) or an antipsychotic should be considered.
64
Obsessive-compulsive personality disorder
Involves a pattern of preoccupation w/ orderliness, perfectionism, and control.
Differentiated from obsessive compulsive disorder (ego dystonic-distressed by sxs) by lack of true obsessions and compulsions and by ego syntonic nature of symptoms (comfortable w/ behaviors).
65
What is Rett syndrome?
Mutation in X-linked MECP2 gene
Occurs mainly in girls
Normal development w/ subsequent regression of speech, loss of purposeful hand movements, gait abnormalities, stereotypical hand movements at 6-18mo
Deceleration in head growth may be an early sign
Seizures occur in majority of cases and are increasingly prevelent w/ age
Regression is usually slow bu tmay occur suddenly
66
Serotonin syndrome
Most antidepressants should be discontinued 2 weeks before beginning an MAOI to avoid serotonin syndrome.
Fluoxetine is an exception due to its long 1/2life and must be stopped 5 weeks before initiating an MAOI.
67
Suicide + adolescents
A teenerage w/ active suicidal ideation must be hospitalized for safety and the parents must be informed.
In cases where there is risk of harm, confidentiality should be be maintained - the parents should be informed.
Parental consent is ideal but not required for hospitalization.
68
Prescription drug misuse.
Risk factors for prescription opioid use: age <45, psych disorder, personal or fhx of substance disorder, or a legal hx
Review of state's prescription drug-monitoring program data, random urine drug screens, and regular follow up (q3mo) are all assoc. w/ risk reduction for long-term prescription opioid misuse.
69
Depression + cortisol
MDD is assoc. w/ hyperactivity of the hypothalamic-pituitary adrenal axis, resulting in increased CORTISOL levels.
Decreased hippocampal and frontal lobe volumes
Decreased REM sleep latency (time from sleep onset until start of 1st REM sleep period)
Decreased slow wave sleep
70
Schizophrenia + ventricles
Enlarged lateral cerebral ventricles
71
What is persistent depressive disorder?
Characterized by chronic depressed mood and >= 2 other depressive sxs lasting for >= 2 years.
Tx: antidepressants and/or psychotherapy can improve symptoms and quality of life.
72
What is language disorder?
Characterized by persistent difficulties in comprehension (receptive) and/or production (expression) of spoken and written language.
May involve rules (grammar, syntax, morphology), content (vocabulary), and/or functional use of language.
Limited vocab, sentence structure, functional use of language.
73
What is childhood-onset fluency disorder?
Also known as stuttering
| An impairment in the fluency of speech production
74
Speech sound disorder
Impairment in speech articulation
75
What is social (pragmatic) communication disorder?
Characterized by persistent difficulty in the social use of verbal and nonverbal communication.
76
What are sleep terrors?
A common and usually benign parasomnia of childhood.
Occurs during non-REM sleep and characherized by fear, crying and/or screaming, and amnesia of the event.
Dx: clinical
Parents should be reassured that episodes are self-limited and typically resolve w/1-2 years.
77
Nightmare Disorder
Involves recurrent wakening from REM sleep during latter half of sleep assoc. w/ full alertness and dream recall.
Upon awakening, child is fully alert, remembers dream, and can usually be consoled.
Tx for anxiety w/ related nightmares - CBT
78
Refusal of treatment
Pt w/ psychotic illnesses do not necessarily lack decision making capacity. If a pt's psychotic sxs do not interfere w/ understanding or ability to communicate a choice regarding medical treatment, the pt has the right to refuse treatment, even if it would be lifesaving.
79
Suicide
It is a physician's duty to use clinical judgement when assessing suicide risk. Even if a patient denies a suicide attempt, when a likely attempt has been made and the risk of further self harm remains high, the pt must be hospitalized (involuntarily if necessary) to ensure safety.
80
Drug screens
Standard urine drug screens test for opioid use by measureing morphine, a breakdown product of all natural, nonsynthetic opioids (eg heroine, codeine).
Semisynthetic (hydrocodone, hydromorphone, oxycodone) and synthetic (fentanyl, meperidine, methadone, tramadol) opioids are not detected on standard testing.
81
Drug induced parkinsonism
Medications that block the dopamine (D2) receptor (eg antipsychotics, metocloperamide) may cause extrapyramidal symptoms, including acute dystonia, parkinsonism, akathisia, and tardive dyskinesia.
Drug induced parkinsonism typically presents w/ bradykinesia, rigidity, and tremor (may be asymmetric or symmetric).
82
Intellectual disability
Children w/ isolated intellecutal disability typically exhibit social responsiveness appropriate to their developmental level.
83
Timeline for postpartum mood disorders
Postpartum blues: 2-3d, resolves by 2 weeks
Postpartum depression: 4-6w can be up to 1 year (SSRI-sertraline TOC)
Postpartum psychosis: days to weeks
84
What is atypical depression?
Core feature: mood reactivity (ie positive responsiveness to pleasant events)
Increases appetite or wt gain, hypersomnia, leaden paralysis (heavy feeling in limbs), and hypersensitivity to rejection
In contrast, the melancholic subtype of MDD is characterized by wt loss, insomnia, and pervasive anhedonia w/ an inability to respond to positive events.
85
Bipolar disorder
History of manic episode and MDD = bipolar I
When severe, may have psychotic features (hallucinations, delusions).
Doesn't need to have psychotic features in manic episode.
If pyschotic sxs occur, they are only present in context of a manic or major depressive episode.
86
Bipolar vs. ADHD
```
Pt w/ BP disorder may exhibit distractibility and hyperactivity that are difficult to distinguish from symptoms of ADHD.
An episodic (not chronic) course and prominent mood sx are more characteristic of BP disorder.
```
87
Lithium + hypothyroidism
Approx. 25% of pts treated with Li will develop hypothyroidism, requiring that all pts have regular TSH monitoring every 6-12mo.
Li-induced hypothyroidism is generally treated with T4 supplementation (eg Levothyroxine) rather than discontinuation of Li.
88
Psychosis + Parkinson's
```
Psychotic symptoms, visual hallucinations and paranoid delusions, are a frequent complication of Parkinsons.
Dopamine agonists (eg pramipexole, ropinirole) are assoc. w/ a greater risk of psychosois than carbidopa-levodopa.
Tx: dose reduction of antiPD meds, med substitiution, or addition of low potency antipsychotic med
Quetiapine, clozapine, pimavanserin are preferred b/c they have minimal D2 receptor antagonism
Haloperidol, risperidone should be avoided b/c they have more potent D2 receptor antagonism and the highest risk of extrapyramidal symptoms and will worsen Parkinson motor symptoms.
```
89
Amantadine + selegiline for PD psychosis
Dopaminergic agents used in tx of PD.
| Inferior to pramipexole as antiPD agents and are assoc. w/ psychosis due to dopaminergic activity.
90
Antidepressnts + cardiac disease
SSRI are first line after acute MI b/c they are generally well tolerated and less likely to cause adverse cardiac effects.
Sertraline is preferred b/c it carries a very low risk of adverse drug interaction, especially w/ cardiac meds.
Citalopram is generally avoided in pts w/ a recent MI due to its potential for dose-dependent QT prolongation.
91
Inhalants
glue, toluene, nitrous oxide, amyl nitrate, and spray paints
Immediate effects that last 15-45m: transient euphoria and loss of consciousness
Dermatitis (glue sniffer's rash) due to chemical exposure can be seen around the mouth or nostrils
Liver function tests may be elevated w/ repeated use.
Chronic abuse of NO: B12 deficiency and resultant polyneuropathy
RF: Boys 14-17y
92
Hallucinogens
Do not usually cause LOC.
93
What is displacement?
Immature defense mechanism involving transfer of emotions assoc. w/ an upsetting object or person to a safer alternate object or person.
94
What is projection?
Attributing one's own feelings to someone else.
95
What is reaction formation?
Involves transforming unacceptable feelings into their extreme opposites.
96
What is gender dysphoria?
The persistent, intense desire to be another gender, which leads to significant distress and may be assoc. w/ depression, anxiety, and bullying.
Physicians should provide nonjudgemental support and collaborate w/ medical and mental health specialists to tailor management to each pt's needs.
97
What are age-related sleep changes?
Normal, age-related sleep changes include decreased total sleep time, increased nightime awakenings, sleepiness earlier in the evening w/ early morning awakening, and increased daytime somnolence (napping).
98
Treatment for depression.
The combination of an antidepressant and psychotherapy (CBT, interpersonal psychotherapy) is more effective than either alone.
Long term maintenance antidepressant therapy is indicated for pt w/ 2= major depressive episodes.
99
ADHD
DX requires several symptoms to be present before age 12.
100
What is avoidant/restrictive food intake disorder?
Lack of interest and avoidance of eating based on the sensory characteristic of food, w/ typical onset in infancy or early childhood.
101
Long acting injectables
FGA: Haloperidol, fluphenazine
SGA: Risperidone, paliperidone, olanzapine, aripriprazole
Administered every 2-4weeks
Antipsychotic mediation adherence is a common cause of relapse and rehospitalization in pts w/ schizophrenia.
Long acting injectable antipsychotics are useful for patients who have responded to oral antipsychotics but who relapse frequently due to medication nonadherence.
102
What is benozdiazepine withdrawal?
Abrupt discontinuation of a benzodiazepine can result in a potentially life-threatening withdrawal syndrome.
Presentatoin: anxiety, insomnia, tremors, psychosis, seizures
Shorter actign drugs (alprazolam, lorazepam) produce earlier and more severe symptoms; produces withdrawal sxs w/in 1-2d (due to 1/2life of 12h)
Strategies for managing withdrawal include using a longer 1/2 life benzo (diazepam) and gradually tapering it over several months.
103
Abrupt discontinuation of antidepressant.
May be assoc. w/ a withdrawal syndrome that includes anxious and depressive exacerbations
Symptoms are more severe in antidepressants w/ a short half-life (eg paroxetine)
Fluoxetine's 1/2life (ie 4-6d w/ chronic use) makes it unlikely to cause clinically significant withdrawal after only 2 missed doses.
104
Risperidone
Known to have a high frequency of prolactin elevation.
Aripiprazole and quetiapine are two of the least likely drugs to produce hyperprolactinemia.
105
What is neonatal abstinence syndrome?
Caused by infant withdrawal to opiates and usually presents in the first few days of life.
Characterized by irritability, a high pitched cry, poor sleeping, tremors, seizures, sweating, sneezing, tachypnea, poor feeding, vomiting, and diarrhea.
106
What is factitious disorder?
Intentional falsification of illness in absence of obvious external rewards.
Motivated by desire to assume sick role.
107
Malingering
Falsification of exaggeration of sxs to obtain external rewards
108
What is persistent complex bereavement disorder?
Prolonged grield >12mo after loss
Characterized by prolonged grief, difficulty accepting the death, persistent yearning for the deceased, and maladaptive ruminative thoughts and behaviors.
Tx: psychotherapy
109
Neuroleptic malignant syndrome treatment
Dopaminergic agents that can reverse dopamine blockade, such as bromocriptine or amantadine, can be considered in pts who do not respond to supportive care and w/drawal of meds causing condition.
Dantrolene, a direct acting muscle relaxant has also been used.
110
Depression treatment failure
When major depression fails to respond to an initial SSRI trial, pts should be switched to another first line antidepressant.
Options include a different SSRI, SNRI (venlafaxine), bupropion, mirtazapine, serotonin modulators (vilazodone).
111
Ventricular tachycardia
Stable pts w/ wide complex tachycardia can be initially managed w/ antiarrhythmic drugs (eg amiodarone**, procainamide, sotalol, lidocaine)
Synchronized electrical cardioversion is indicated for pts w/ persistent tachyarrhythmia who are severely symptomatic (altered mental status, acute HF or pulmonary edema, ischemic chest pain) or HD unstable (hypotension, signs of shock).
Procainamide, sotalol, and lidocaine reserved for pts who do not respond to amiodarone.
112
Carotid massage
Useful vagal maneuver to terminate paroxysmal supraventricular tachycardia.
PSVT usually a regular narrow-complex tachycardia; fusion beats are not seen.
113
Obsessive compulsive disorder
First line treatment includes SSRI and/or exposure and response prevention based CBT.
Fluvoxamine, sertraline are safe and effective in tx of pediatric OCD.
CBT: most effective form of psychotherapy and involves exposing patients to thoughts, images, and situations that make them anxious and preventing the accompanying compulsion.
114
What is caffeien intoxication?
Caffeine is a stimulant that, when used in excessive amounts can cause sympathetic hyperactivity, leading to anxiety, jitteriness, insomnia, palpitations, and tremores.
Energy drinks typically contain large amounts of caffeine and should be considered as a cause of stimulant intoxication.
115
Major depressive disorder
Characterized by major depressive episodes and no history of mania.
116
Lamotrigine
Used as a mood stabilizer in bipolar disorder and is often used specifically to target bipolar depression.
Most significant side effect: rash of SJS
117
What is premenstrual dysphoric disorder?
Characterized by cyclical mood swings, irritability, appetite changes, and physical discomfort that resolve after menses.
It is not diagnosed when premenstrual mood symptoms represent an exacerbation of an underlying disorder in which the symptoms are not limited to the premenstrual phase.
118
Elderly + Depressed
Eldery, depressed pts can have significant cognitive impairment that may be mistaken for a dementing syndrome.
However, unlike most dementias, depression-related cognitive impairment is reversible w/ treatment of the underlying depression.
119
Bulima nervosa
Involves recurrent binge eating and compensatory behaviors.
| In contrast to pts w/ anorexia nervosa, those w/ bulima nervosa are normal weight to overweight.
120
Binge eating disorder
Characterized by recurrent episodes of being eating, but does not include the inappropriate compensatory behaviors seen in bulima nervosa.
121
Antidepressants + suicide risk
The slightly increased risk of antidepressant related suicidal thoughts and behaviors (not completed suicide) in some children and adolescents must be weighed against the efficacy of antidepressants and the risk of completed suicide in depression.
Pt should be carefully monitored for suicidality at the beginning of antidepressant therapy.
122
Psychiatric hospitalization
Indications for psychiatric hospitalization include being a danger to self or others and/or grave disability.
Hospitalizaiton may be implemented on an involuntary basis if necessary.
123
Amphetamine intoxication
Can present w/ psychiatric symptoms, including irritability, agitation, and psychosis(w/ or w/o delirium).
Common physical signs: tachycardia, HTN, hyperthermia, diaphoresis, and mydriasis
Other complications: cardiac arrhythmias, seizures, hyperthermia, intracerebral hemorrhage
124
Opioid withdrawal.
Lasts 3-5 days.
125
Shared psychotic disorder (Folie a deux)
The dominant person's delusion is transferred to a more submissive partner.
It is important to separate the individuals to determine the degree of impairement in each.
Separation can also be used as a therapeutic measure to break the cycle of mutual reinforcement.
