Psych/Behavioral Med Flashcards by Alice Richards

anxiety d.o to know

GAD: 6 mos
panic d.o: >/= 1 mo
phobias

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-recurrent, unexpeted panic attacks with at least 1 month or more of worry or avoidant behavior
+/- agorahobia
-sx develop abruptly and reach a peak w.in 10 min

panic disorder

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tx for agoraphobia

SSRI
CBT

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bipolar related disorders

bipolar I: mostly mania
bipolar II: mostly dpn, hypomania
cyclothymic

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hypomania alternating w. long standing dysthymia x 2 years

cyclothymic d.o

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squandering savings
destroying relationships
neglecting work

bipolar I

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first line tx for bipolar I

lithium

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tx for bipolar I

acute mania: lithium, valproate, SGAs
mania maintenance: SGAs, gabapentin, lamotrigine
agitation: haldol, risperidone, benzo

fam/group/CBT

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hypomania is defined as

-not severe enough to cause marked impairment in social/occupational functioning
-no hospitalization
-no psychotic features

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tx for bipolar II

quetiapine vs olanzapine + fluoxetine
fam/group therapy/CBT

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less intense, longer acting form of bipolar

cyclothymia

highs and lows, but never as severe as mania or major dpn

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4 types of depressive disorders

mdd
persistent depressive d.o (dysthymia)
premenstrual dysphoric d.o
suicidal/homicidal behaviors

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mdd is _ or more of significantly depressed moods

2 weeks

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persistently depressed mood w. low self esteem, withdrawal, pessimism, or despair x at least 2 years w. no absence for more than 2 months

persistent depressive d.o (dysthymia)

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significant dpn and related sx during the week before menstruation

premenstrual dysphoric d.o

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mood d.o, somatic complaints, feeling hopelessness, worthlessness, helplessness

suicidal/homicidal, behaviors

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dsm 5 for mdd

5 or more sigecaps >/= 2 weeks, nearly every day - at least one sx is depressed mood or anhedonia

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what does sigecaps stand for

sadness
interest/anhedonia
guilt
energy
concentration
appetite
psychomotor activity
suicidality

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how do you uptitrate SSRIs

increase dose q 3-4 weeks until sx are in remission

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30 yo M feeling down most of the time x 3 years - frequent intruisive thoughts of inadequacy despite success - he tries to overcompensate by taking on more than he can handle, which leads to failure and furthers feelings of inadequacy

persistent depressive d.o (dysthymia)

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with dysthymia, the pt never experiences

mania/hypomania

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dsm 5 premenstrual dysphoric d.o

-at least 5 sx the final week before onset of menses
-improve w.in a few days after onset of menses -
-resolve in the week post menses

one or more must be present:
-affective lability
-interpersonal conflicts
depressed mood
-anxiety
-decreased interest
PLUS
one or more:
-difficulty concentrating
-lethargy
-change in appetite
-insomina
-overwhelmed
-physical (bloating, breast tenderness etc)

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tx for premenstrual dysphoric d.o

-SSRIs continuously vs week prior to menses
-OCP
-diuretics
-SNRI
-GnRH

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SNRIs are esp useful for premenstrual dysphoric syndrome when symptoms are mostly

psychological

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2 sx of GnRH

bone loss vasomotor sx

6 rf for suicide

male older mdd active SUD chronic conditions recent loss (employment, relationships, death)

acute cognitive dysfxn 2/2 underlying medical condition - reversible

delirium

mc type of hallucination associated w. delirium

visual

pt's esp high risk for delirium

post surgery w. heart disease or DM

mc presentation of AMS in inpt setting

delirium

mc cause of delirium

etoh abuse

delirium is a common s.e of _

hyperthyroidism *thyroid storm*

causes of delirium (7)

UTI PNA metabolic changes CVA MI TBI meds

3 meds associated w. delirium

anticholinergics benzos opioids

don't forget to order this in a febrile pt w. delirium

pharm for agitatiion/psychosis w. delirium

haldol

disorders w. a significant or moderate impairment of cognition or memory that represents a marked deterioration from a previous level of fxn

neurocognitive d.o

mild/moderate neurocognitive d.o are same same

dementia

causes of dementia

alzheimer's frontotemporal lobar degeneration lewy body dz vascular dz TBI SUD meds HIV prion dz parkinson's huntington's

what are the 2 cognitive exams

MMSE MoCA

what class of drug may temporarily improve cognitive fxn

cholinesterase inhibitors: donepezil galantamine rivastigmine

2 hallmark bx findings in alzheimer's

bate amyloid plaquees neurofibrillary tangles

what type of dementia is characterized by personality changes preceding memory changes

frontotemporal lobar degeneration

what type of dementia is characterized by parkinsonian sx

lewy body

2 mc types of dementia

1. alzheimer's 2. vascular dementia

what type of dementia is associated w. arteriosclerotic dz and may involve a sudden decline in mental status

vascular dementia

what dementia is associated w. hallucinations, delusions, gait difficulties, and falls

lewy body

what dementia is associated w. language difficulties, personality changes, and behavioral disturbance

frontotemporal lobar

what type of dementia has a rapid onset and is very rare

creutzfeldt jakob

bx finding of HIV associated dementia

cerebral atrophy

dsm 5 for panic d.o

**-3 panic attacks in 3 weeks** **-at least one has been followed by at least one month of one or both:** -worry about additional attacks -maladaptive change in behavior related to attacks

diagnostic criteria for for ptsd

-traumatic event -> acute stress rxn -sx persist past one month

tx for ptsd

ssri's prazosin for nightmares

schizophrenia spectrum

delusional d.o schizoaffective d.o schizophrenia schizophreniform d.o

normally functioning person w. a belief in something that does not exist

delusional d.o

-psychotic d.o characterized by BOTH schizophrenia and a major mood d.o (dpn, bipolar) -sx may occur at the same time

schizoaffective d.o

psychotic d.o associated w. delusions, hallucinations, disoganized speech, and/or diminished inappropriate emotional expression > 6 months PLUS difficulty functioning

schizophrenia

-psychotic d.o involving the sx of schizophrenia > 1 week, < 6 months -no social/occupational impairment

schizophreniform d.o

common delusions associated w. delusional d.o

**non bizarre delusions - beliefs that occur in real life** -poisoning -stalking -being loved or deceived -having an illness **beliefs last > 1 month**

tx for delusional d.o

atypical antipsychotics -olanzapine -risperidone

45 yo M - hearing things that aren't there x 2 weeks, severely depressed - hearing things - life is not impaired by hallucinations at this time

schizoaffective d.o

dsm 5 for schizoaffetive d.o

schizophrenia PLUS mood d.0 x 2 or more weeks

tx for schizoaffective d.o

atypical antipsychotics SSRIs

26 yo M - hearing voices of ppl plotting to kill him - has missed multiple days of work and was recently fired - he is dishevled, incoherent, and has disorganized speech - was normal until 8 months ago

schizophrenia

major psychosis x 6 months or more + difficulty functioning

schizophrenia

dsm 5 for schizophrenia

2 or more of the following x 6 months: -delusions -hallucinations -disorganized speech/thought/behavior -impaired ADLs -negative sx -inability to maintain job/relationships

what are negative sx

blunted affect poor posture lack of goal-direct activities/initiatives

tx for schizophrenia

SGAs clozapine FGAs

what drugs are most effective for positive sx

**FGAs:** haldol chlorpromazine thioridazine loxapine fluphenazine

what SGA is not first line due to risk for agranulocytosis

clozapine

pharm for tx resistant schizophrenia

clozapine OR SGA PLUS benzo/carbamazepine/valproate/lithium

3 s.e of antipsychotics

parkinsonism neuroleptic malignant syndrome TD

mc type of hallucination w. schizophrenia

auditory

23 yo M grad student - visual and auditory hallucinations x 2 months - he is able to attend classes but having difficulty focusing - dad has schizophrenia - takes no meds - labs/imaging nl

schizophreniform d.o

dsm 5 for schizophreniform d.o

-major psychosis > 1 week but < 6 mos -no social/occupational impairment

schizophrenia and schizophreniform are basically same-same, what differentiates them

**schizophreniform d.o:** > 1 week, < 6 mos **schizophrenia:** > 6 mos, social/occupational impairment

tx for schizophreniform d.o

**SGAs** resistant: consider lithium, anticonvulsants

types of abuse/neglect

child abuse domestic violence elder abuse sexual abuse spouse/partner neglect/violence

what type of fx makes you concerned for child abuse

spiral fx

2 types of burns that make you suspect child abuse

doughnut shaped stocking-glove

child abuse may manifest as

anxiety aggression PTSD dpn/suicide SUD poor self esteen dissociative d.o paranoid FTT

t/f: neglect can be considered if a minor is allowed to engage in etoh

definition for domestic violence

any act of violence against family members

child sexual abuse is mc in ages _ and is often done by _

9-12 male known to child

moa for etoh

-increases GABA channel opening -longterm: downregulation of GABA channels -> inhibitory -upregulation of NMDA -> excitatory

tx for etoh withdrawal (5)

thiamine folate MVI IVF w. dex benzos

delirium tremens happens w.in _ hr of etoh withdrawal onset

48-96

4 sx of delirium tremens

autonomic instability disorientation hallucinations agitation

5 addiction medications

disulfram (antabuse) naltrexone: oral vs extended release acamprosate topiramate gabapentin

what 3 addiction meds decrease desire to drink

naltrexone topiramate gabapentin

what addiction med inhibits acetaldehyde dehydrogenase and leads to aversive conditioning

disulfram (antabuse)

what addiction med changes brain chemistry to reduce anxiety, irritability, and restlessness - leads to early sobriety

acamprosate

etoh withdrawal timeline

moa for anxiolytics

increase frequency of GABA channel opening

intoxication vs withdrawal sx of benzos

**intoxication:** respiratory dpn, hypotn, amnesia, ataxia, stupor/somnolence, coma, death **withdrawal:** rebound anxiety, tremor, sz

tx for benzo intoxication vs withdrawal

**intoxication:** flumazenil (GABA antagonist) **withdrawal:** clonazepam (long acting benzo)

moa for cannabis

binds to CB1/CB2 receptors

what drugs are associatd w. simulant related d.o (3)

cocaine amphetamines

moa for cocaine vs amphetamines

**cocaine:** block reuptake of DA, NE, 5HT **amphetamines:** stimulates DA, NE, 5HT release PLUS decrease reuptake

what are the biogenic amines (3)

dopamine (DA) norepinephrine (NE) serotonin (5HT)

tx for stimulant intoxication

antipsychotics benzos labetalol alpha 1 blockers vitamin C

what pharm promotes excretion of cocaine

vitamin C

never _ a pt w. cocaine intoxication

restrain *risk for rhabdo*

pharm for stimulant withdrawal

bupropion bormocriptine SSRIs

what 2 drugs are associated w. hallucinogen related d.o

PCP LSD

pt is extremely aggressive and becomes enraged w. sudden movements or w. loud sounds

PCP

moa for PCP

NMDA antagonist like ketamine

6 PE findings of PCP intoxication

belligerence fear homicidality psychosis vertical AND horizontal nystagmus tachycardia

tx for PCP intoxication (4)

haldol benzos low stimulatn environment restraints

tx for PCP withdrawal

symptomatic

pt wants to hurt himself - freaking out and hallucinating

LSD

moa for LSD

5HT agonist

tx for acute LSD intoxication

haldol benzos talk down/supportive counseling

why isn't LSD associated w. withdrawal

does not affect DA

leading cause of preventable death in US

tobacco

3 meds or tobacco cessation

bupropion varenicline (chantix) NRT

which tobacco cessation med has highest success rates

varenicline *esp when used w. NRT*

4 sx of inhalant intoxication

belligerence/assault apathy blurred vision coma

tx for inhalant intoxication

supportive +/- haldol

tx for opioid withdrawal

clonidine methadone suboxone - withdrawal if given too early

Psych/Behavioral Med Flashcards

(120 cards)