Psychiatry Flashcards by J D

Boys>girls
lack peer relationships, poor eye contact, & social smile.
Absent or bizarre speech, repetitive behaviors (stacking) , injurious behavior to self or others.

Autistic

Tx: Improve ability to develop relationships, attend schools, & achieve independent living.
Behavioral modifications, ANTIPSYCHOTIC Meds if aggressive.
Disorder

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Girls> Boys;

Progressive encephalopathy, microcephaly, hand-wringing, loss of speech, ataxia, psychomotor retardation.

Rett Disorder

Tx: symptomatic, behavior therapy for self injurious behavior, physiotherapy for muscular def.

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Boys> girls
Normal development for 2 yrs & then regressions.
Loss of language, social interaction, motor, bladder function. Repetitive/stereotyped behaviors.
r/o infection then r/in CDD.

Childhood Disintegrative Disorder

Tx: behavioral modification, develop relationships, attend school, achieve independent living

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Boys> Girls.

Social problems. No intellectual deficits. Preoccupied with rules.

Asperger Disorder

Tx: Improve social relationships with others

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Inattention, short attention span or hyperactivity that interferes with daily functioning
Usually appears before age 7, must be present for > 6 mos. May persist in adulthood
Must be in 2 areas (home &outside of home)
Comorbid w/learning disability.

ADHD

Tx: Methlyphenidate & dextroamphetamine
SE: insomnia, decreased appetite and headache
2nd line: atomoxetine (norepinephrine reuptake inhibitor)

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Argues often, loses temper, easily annoyed, blames other for their mistakes, tends to have problems with authority figures. Justifies behavior as response to others actions

Oppositional Defiant disorder

Tx: Teach child management skills . No pharmacological treatment.

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Leads to Anti-social Personality disorder
Persistent behaviors where rules are broken, cruelty to animals, bullying, fighting, using weapons.
Vandalize and destroy property, set fires, steal items from others or lie to obtain good from others.

Conduct Disorder

Tx: behavior with giving rewards for normal behaviors
Aggressive? Give antipsychotic meds.

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Characterized by onset of multiple tics. Lasting > 1 yr.
Facial and neck muscles most commonly involved.
Vocal tics include grunting, coughing, &throat clearing.
Boys> girls; begins at age 7

Tourette Disorder

Tx: Dopamine antagonists- antipsychotics medications (Risperidone)

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At least 2 wks of symptoms.
Depressed mood/Anhedonia + 4 of the following
Depressed mood most of the day, weight changes, sleep changes, fatigue, poor concentration, thoughts of death and worthlessness and psychomotor disturbance.
r/o medical causes: Thyroid hormone,Parkinson and dementia

Major Depression

Tx: SSRI (Fluoxetine, paroxetine, sertraline, citalopram, escitalopram)
Increase the dose of SSRI
Psychotherapy: w/goal of teaching patients to identify negative thoughts

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SSRI +MAOI

Serotonin Syndrome

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Depression + Neuropathic Pain

Desvenlafaxine

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Depressed + fears weight gain

buproprion

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Manic symptoms that last at least 1 week. Cause significant distress in level of functioning.
Elevated mood, increased self-esteem, distractability, pressured speech, decreased need for speech.
Increase in goal directed behavior, racing thoughts, excessive involvement in pleasurable activities.

Bipolar Disorder
Tx:
Acute Mania: Lithium, Valproic Acid, Atypical Antipsychotics
Severe symptoms consider: atypical antipsychotics: shorter onset of action
Bipolar Depression: Lithium, Lamotrigine
Compromised Kidneys? DON’T USE LITHIUM!

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Depressed mood for most of the day.

Symtoms must be present for > 2yrs.

Dysthymia

Tx: antidepressant medications and psychotherapy

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Hypomanic episodes & mild depression. Symptoms present for > 2 yrs.

Cyclothymia

Tx: Lithium, valproic acid, carbamazepine, Psychotherapy

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Increased sleep, weight, and appetite.

Moods tend to be worse in evenings & pts may complain of extremities feeling heavy

Atypical Depression

Tx: SSRI or MAOI

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Weight gain, increased sleep, lethargy

Seasonal Affective Disorder

Tx: Phototherapy, and bupropion

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Onset : immediate birth up to 2 wks. Sadness, labile mood, tearfulness. Love baby lots.

Baby Blues

Tx: supportive

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Onset 1- 3 mos after birth.

Depressed mood, weight changes, sleep disturbances, & excessive anxiety, may have neg feelings toward baby.

Depression

Tx: Antidepressant

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Onset 2-3 wks after birth.
Wants to harm baby.
Depression, delusions, and thoughts of harm.

Psychosis

Tx: antipsychotic med, lithium, possibly antidepressant

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No functional impairment then don’t treat.
Begins after the death of loved one
Sadness, worrying, irritability, sleep difficulties, poor concentration, tearfulness

Bereavement

Tx: supportive psychothearpy

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TCA (-triptyline)

Side Effects

Hypotension, Dry mouth, Constipation, Confusion, Arrhythmia, Sex SE, Weight gain, GI disturbance

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MAOI Side effects

Phenelizine, Isocaboxiazid, tranylcypromine

Monitor diet

Causes HTN

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SSRI Side effects

Fluoxetine, paroxetine, sertraline, citalopram, Escitalopram, Fluvoxamine

Headaches, weight changes, sexual SE, GI disturbances

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SNRI Side Effect | Venlafaxine, Duloxetine, Desvenlafaxine

HTN, Blurry vision, weight changes, sexual side effects, GI

Bupropion Side Effect

Seizures

Trazadone Side Effect

Priapism

Mitrazapine Side Effect

Weight gain and sedation

Lithium Side Effect

Tremors, weight gain, GI, nephrotoxic, diabetes, leukocytosis, teratogenic

Lithium Toxicity

Confusion, ataxia, lethargy, abnormal reflexes

Valproic Acid SE

Tremors, weight gain, GI, alopecia, teratogic, hepatotoxic | Toxicity: hyponatremia, coma death

Lamotrigine SE

Stevens-Johnson Syndrome

ECT SE

Headaches, transient memory loss, single most effective treatment

Agitation confusion, hallucination, hypomania. Sweating, hyperthermia, tachycardia, nausea, diarrhea, shivering, tremors, myoclonus.

Serotonin Syndrome Tx: STOP THE MEDICATION. Symptomatic treatment of fever, nausea, vomiting. Cyproheptadine (serotonin antagonist)

Schizophrenia Treatment

Acutely psychotic- hospitalize- Emergency situation give olanazpine and ziprazidone. Haloperidol was worse SE Atypical antipsychotics Noncomplaint with meds give long acting risperidone. No response to trial of typical or atypical medications: Clozapine

Acute Dystonia

Hours to days Muscle Spasms Tx: Benztrophine, trihexphenidyl, diphehydramine

Akathesia

Weeks Inability to relax, restless Tx: reduce the dose, give beta blockers, switch to atypical antipsychotics

Tardive Diskinesia

Rare before 6 months Abnormal involuntary movement esp perioral Tx: Atypical antipsychotic, clozapine least risk

Neuroleptic Malignant Syndrome

Not time limited, muscular rigidity, fever, autonomic changes Tx: Dantrolene or bromocriptine

Nonbizarre delusion >1 month, & no impairment in level of functioning Hallucinations are not present

Delusional Disorder Tx: Atypical Antipsychotics: First line Psychotherapy can help pts feel things are safer than they believe

Dread and Doom Diaphoresis, SOB, nausea, dizziness, trembling, chest pain, fear of dying, chills, dissociative symptoms, palpitations, paresthesias r/o MI, thyroid, hypoglycemia, cardiac disease Lasts

Panic Disorder Tx: SSRI, typically (Fluoxetine, paroxetine, sertraline) Benozdiazepine- taper the dose down to monitor Behavioral therapy

GAD Treatment

Busiprone

Panic Attack

Alprazolam

Specific or Social Phobia Treatment

``` Tx: behavioral modification techniques, Systematic desensitization. Relaxation techniques (breathing guided imagery) ```

Performance anxiety

beta-blockers. | Given 30 mins to hr before performance.

Affect the pts level of functioning. Obsessions: thoughts that are intrusive, senseless, & distressing, thus increasing anxiety. Compulsions: neutralize the thoughts they are rituals Young pts; men=women, coexist w/tourette disorder

OCD Tx: SSRI: treatment of choice (Fluoxetine, paroxetine, sertraline, citalopram, or fluvoxamine) Behavioral therapy –exposure therapy

Symptoms: Increased startle, hypervigilance, sleep disturbances, concentration issues, anger outbursts. Symptoms last > 1 mon

PTSD

Symptoms: Increased startle, hypervigilance, sleep disturbances, concentration issues, anger outbursts. > 2 days

Acute Stress Disorder

PTSD/Acute Stress Disorder

Tx: First-line: Paroxetine & sertraline Relaxation Psychotherapy to get coping techniques

Excessive anxiety or worry lasting greater than 6 months. Anxiety out for proportion to event. symptoms: fatigue, concentration difficulty, sleep problems, muscle tension, restlessness. Usually women

Tx: SSRI (Fluoxetine, paroxetine, sertraline, citalopram) Venlafaxine and busiprone Psychotherapy and behavioral therapy—not first line

Diazepam, lorazepam, clonazepam, alprazolam, oxazepam, chlordiazepoxide, temazepam, flurazepam

Benozodiazepines | SE: sedation, confusion, memory deficits, respiratory depression, addiction potential

Busiprone SE

SE: Headaches, nausea, dizziness

Lorazepam

given IM in emergencies

Clonazepam

longer half live- give if addiction is a concern

Chlordiazepoxide, oxazepam-

used frequently in treatment of alcohol withdrawal

Flurazepam, temazepam, triazolam

approved for hypotics

Flumazenil is a

benzodiazepine antagonist

Flumazenil indications

the overdose is acute & you are certain that there is no chronic dependence

Flumazenil SE

seizures in benzodiazepine-dependent patients. causes acute withdrawal: tremor or seizures similar to delirium tremens

talkative, sullen, disinhibited, moody, gregarious

Alcohol Intoxication | Tx: mechanical ventilation if severe

tremors hallucinations, seizures, delirium tremens,

Alcohol withdrawal | Tx: benzodiazepine, thiamine, multivitamins, folic acid

Euphoria, hypervigilance, autonomic hyperactivity, weight loss, papillary dilation, perceptual disturbances

Cocaine/Amphetamine Intoxication | Tx: Antipsychotics and/or benzodiazepine and/or antihypertensives

anxiety, tremulousness, headache, increased appetite, depression, risk of suicide

Cocaine/Amphetamine Withdrawal | Tx: Bupropion and/or bromocriptine

Intoxication: Ideas of reference, perceptual disturbances, impaired judgment, tremors, incoordination, dissociative symptoms

Hallucinogen Intoxication | Antipsychotics and/or benzodiazepines and/ or talking down.

belligerence, apathy, aggression, impaired judgement, stupor, coma

Inhalant Intoxication | Tx: Antipsychotics

apathy, dysphoria, papillary constriction, drowsiness, slurred speech, coma, death

Opiates Intoxication | Naloxone

Fever, chills, lacrimation, abdominal cramps, muscle spasms, diarrhea

Opiates Withdrawal | Tx: clonodine, methadone, buprenorphine

belligerence, psychomotor agitation, violence, nystagmus, HTN, seizures

PCP Intoxication | Tx: antipsychotics and/or benzodiazepines and/or talking down

young, irritability, aggression, mania, psychosis

Anabolic steroid intoxication | Tx: antipsychotics

depression, headaches, anxiety, increased concern over body's physical state

Anabolic Steroid withdrawal | Tx: SSRI

Somatoform disorder | Tx: Psychotherapy

Young women, unaware of psychological problems | Symptoms: 4 pain, 2 GI, 1 sexual, 1 pseudoneurological symptoms

Hypochondriasis:

Patients believe that they have some specific disease despite constant reassurance.

Conversion Disorder

voluntary motor or sensory functions, indicative of a medical condition Unconcerned about impairment in the associated La Bell Indifferance

Body Dysmorphic Disorder

Patients believe that some part of the body is abnormal, defective, or misshapen

Pain Disorder

Pesence of pain, psychological factors associated with pain.

Facitious disorder (Munchausen) Tx: no specific therapy

Individual fakes an illness to get attention &emotional support in pt role Either psychological or physical illness Hx of being employed by healthcare Rule out medical disorder Peptide c- levels. Call child protective services.

Malingering | Tx: Confront the pt

Conscious production of signs and symptoms for an OBVIOUS gain Not a mental disorder Patient: Prisoners and military personnel Typically diagnosed when there is a discrepancy between the complaints and the physical/lab findings

Adjustment disorder | Tx: psychotherapy, individual and group

Characterized by maladaptive reaction to an identifiable stressor. Loss of job, divorce or failure in school. If seeing murder or POW that would be PTSD Usually occur w/in 3 mos of stressor &must remit w/in 6 months of removal of stressor. Symptoms: Anxiety, depression, disturbances of conduct Severe enough to cause impairment in functioning.

Suspicious, mistrustful, secretive, isolated and questioning the loyalty of family and friends

Paranoid

Loners, choice of solitary activities, lack close friends, emotional coldness, no desire for or enjoyment of close relationships. Content alone

Schizoid

Ideas of reference, magical thinking, odd thinking, eccentric behavior, increased social anxiety, brief psychotic episodes. Dragon statues, magic 8 ball in the room, dolls are magical and can talk

Schixotypal

Must be center of attention, inappropriate sexual behavior, self-dramatization Use physical appearance to draw attention to self

Histrionic

Failure to conform to social rules, deceitful, lack of remorse, impulsive, aggression towards others, Irresponsible, must be 18 years older

Antisocial | Conduct disorder usually leads to this

Unstable relationships, impulsive, recurrent suicidal behaviors, chronic feelings of emptiness, inappropriate anger, dissociative symptoms when severely stressed, brief psychotic episodes

Borderline

Grandiose sense of self, belief that they are special, lack of empathy, sense of entitlement, Require excessive admiration

Narcissistic

Unwilling to get involved with people, views self as socially inept, reluctant to take risks Feelings of inadequacy. Want friends but unwilling to make risks.

Avoidant

Difficulty making day to day decisions, unable to assume responsibility, unable to express disagreement, fear of being alone, seeks relationships as source of care.

Dependent

Preoccupied with details, rigid, orderly, perfectionists, excessively devoted to work, inflexible

Obsessive Compulsive

Anorexia Nervosa Tx: Electrolytes

SSRI High Bicarb, carotene, LFTs, amylase, cholesterol, cortisol Low K, Cl, LH/FSH, estrogen

Re-feeding syndrome

Low PO4, Mg, Ca, and fluid retention

Bulimia Nervosa

SSRI | Don't give bupropion

Narcolepsy

Sleep paralysis: awake but unable to move Cataplexy: sudden loss of muscle tone, occurs with loud noises and sounds Lack of REM sleep Tx: modafinil, naps

Insomnia

Tx: Sleep hygiene, avoid naps, zolpidem, eszopiclone, zaleplon

Psychiatry Flashcards

(93 cards)