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Flashcards in Psychiatry Deck (139):
1

HY symptoms of depression

anhedonia
weight changes
sleep changes
poor concentration

2

first line agent in depression

SSRI ALONE (without any other antidepressants)

3

2 exceptions to SSRI use in depression

1. depression + NEUROPATHIC PAIN
2. depression +....
- fearful of weight gain
- sexual SE's
- smoker trying to quit

4

tx depression + NEUROPATHIC PAIN

DULOXETINE

5

tx depression +....
- fearful of weight gain
- sexual SE's
- smoker trying to quit

BUPROPION

6

choice of SSRI + antidepressant in depression

WRONGGGGGGG!!!!!
choose the cleanest= SSRI on its own

7

tx mild depression + sleep problems

MIRTAZAPINE,
since= antidepressant + sedative

8

what to exclude with presentation of mania

COCAINE and AMPHETAMINE use....
thus hx and toxicology

9

first line tx acute mania

LITHIUM

10

PC: 33yo man, brought to emergency room, bipolar, recently started on lithium, combative and punches nurse on the mouth. what's the next best mgmt

ADEQUATE TX> admission to psychiatric unit;
ANTIPSYCHOTICS= first line tx

11

tx acute mania with severe symptoms

atypical antipsychotics

12

tx dysthymia

antidepressant meds + psychotherapy

13

tx atypical depression

MAOIs = usually the correct answer

14

seasonal affective disorder

phototherapy-- 12-18 inches from source of 10,000 lux of white fluorescent light without UV wavelengths for 30 minutes each morning; eyes open, but don't necessarily stare at the light

15

tx of normal bereavement

PSYHCOTHERAPY
never never never pharmacology

16

exception to strict diagnosis of major depressive disorder (5/9 for >6months, for 2 weeks)

if the symptoms are SEVERE ENOUGH

17

emergency situation of psychosis tx

IM atypical antipsychotic> haloperidol

18

tx of schizophrenia with psychotic episode, that is unresponsive to typical ro atypical antipsychotics

CLOZAPINE

19

avoid olanzapine in...

diabetics
obese patients

20

big SE of risperidone

MOVEMENT disorders

21

benefit of quetiapine

lower incised of movement disorders; thus ok to use in pots with movement disorders

22

avoid ziprasidone in patients with...

conduction defects since prolongs QT interval

23

clozapine monitor

CBC, since high risk of agranulocytosis
NEVER THE FIRST LINE TREATMENT

24

ariprazole use

ADJUNCT+ for major depressive disorer

25

only antipsychotic that can be used in pregnancy

lurasidone

26

LEAST likely drug to cause weight gain and diabetes in schizophrenia

1. ARIPRAZOLE
2. ZIPRASIDONE

27

timing of movement side effects with antipsychotics...
HOURS--DAYS

ACUTE dystonia

28

tx of acute dystonia

benztropine
trihexyphenidyl
diphenhydramine

29

timing of movement side effects with antipsychotics...
WEEKS

AKATHASIA

30

tx of akathasia

DECREASE dose
beta blockers
switch to atypical antipsychotics
benzodiazepine

31

timing of movement side effects with antipsychotics...
GREATER THAN 6 MONTHS

tardive dyskinesia

32

tx of tardive dyskineasia

switch to atypical antipsychotics

33

LOWEST RISK OF tadive dyskinesia

CLOZAPINE

34

PC delusional disorder

NON-bizarre delusions
NO impairment of functioning
- still obeys law
- goes to work
- pays bills

>1 month

35

tx of manic disorder-- PSYCHOTIC FEATURES and AGITATION

ANTIpsychotics> lithium;
because RAPID action

36

PC panic attack

patient is presenting with autonomic hyperactivity

37

Tx panic attack

benzodiazepines: lorazepam, clonazepam, aprazolam

38

PC pain disorder

patient is giving you STORY/HISTORY of these symptoms
4+ autonomic hyperactivity,

39

Tx panic disorder

SSRI's

40

tx of phobias

behavioural modification
and relaxation techniques

41

tx of performance anxiety-- stage fright

BETA BLOCKERS; 30-60minutes before performance

42

tx of OCD

SSRIs

43

tx of OCD, when all the options are TCAs

CLOMIPRAMINE

44

tx of hoarding disorders

#1: SSR's

can also do behavioural mod or psychotherapy--CBT

45

what to exclude in diagnosis of PTSD

substance abuse--- since will worsen the diagnosis

46

first line treatment for PTSD

paroxetine and sertraline

47

other tx options for PTSD

relaxation techniques

48

tx of GAD

1st line: SSRs
2. venlafaxine
3. buspirone

49

panic disorder vs. GAD

panic disorder: 30 minutes of symptoms
GAD: chronicity of symptoms >6months; constantly worried

50

lorazepam use

IM injection, thus EMERGENCY situations

51

clonazepam use

LONG HALF LIFE-- if worried about addiction--
LOW addiction

52

chlordiazepoxide use

alcohol withdrawal

53

oxazepam use

alcohol withdrawal a/w LIVER problems

54

lorazepam non-emergency use

alcohol withdrawal a/w LIVER problems

55

alprazolam use

panic disorder and panic attack

56

flurazepam use

hypnotic (rarely used)

57

temazepam use

hypnotic (rarely used)

58

triazolam use

hypnotic (rarely used)

59

tx of somatic symptom disorders=
somatoform disorders

PSYCHOTHERAPY

60

PC: patient inflicts life-threatening injury on themselves

in order to get attention... thus FACTITIOUS DISORDER

61

caretaker fakes signs and symptoms on another person (usually a child)

= factitious disorder IMPOSED on others

62

signs and symptoms fakes on oneself

= factitious disorder IMPOSED on self

63

how does a man with factitious disorder present

PHYSICAL symptoms

64

typical PC of factitious disorder

WOMAN
hx of working in HEALTHCARE

65

dx of factitious disorder

MUST confirm by excluding legitimate medical illness

66

tx of factious disorder

NO TREATMENT proven to bed effective
- with child--> child protective services

67

malingering

DOES NOT = MENTAL ILLNESS
PRISONERS/ MILITARY
typically when DISCREPANCY between patients complaints and physical/lab findings
DO NOT COOPERATE

68

tx of acute alcohol intoxication thats severe

mechanical ventilation

69

tx of alcohol withdrawal

long acting benzos
B1
folate

70

PC: drugs- constricted pupils

opiod intoxication

71

PC: drugs- dilated pupils, lacrimation, yawning

opiod withdrawal

72

mgmt opiod withdrawal

methadone
buprenorphine
clonidine

73

PC: drugs- seizures

bento's OR cocaine or PCP

74

PC: drugs- poor sleep and depression and anxious

withdrawal from benzo's

75

PC: drugs- dilated pupils and sweating, and hypertensive

amphetamines intoxication

76

PC: drugs- increase appetite and sedated

amphetamines withdrawal

77

tx of amphetamines and cocaine withdrawal

bupropion and bromocriptin

78

tx of amphetamines and cocaine intoxaication

benzo's
blood pressure mgmt-- ALPHA blockers
antipsychotics

79

withdrawal mgmt of nicotine

buproprion
varenciline

80

PC: drugs- nystagmus and ataxia

PCP intoxication

81

PC: drugs- VIOLENT behaviour

PCP intoxication

82

tx of PCP intoxication

bento's and antisychotics (rapid)

83

PC: drugs- angry, tired, depressed

PCP withdrawal

84

PC: drugs- euphoria and hallucinations

LSD intoxication

85

any withdrawal from LSD or marijuana or inhalants

NOOOOPE

86

PC: drugs- conjunctival injection

marijuana

87

2 synthetic cannabis

1. K2
2. spice

88

PC: drugs- irritable, signs of psychosis, and mania

ANABOLIC STEROIDS

89

withdrawal from anabolic steroids

depression/anxious/headache/
concern over physical appearance

90

PC: drugs- belligerent, apathetic, aggressive, STUPOR-->COMA

inhalants

91

tx of inhalant use

antipsychotics

92

similarities in anorexia and bulimia

purging
fasting
laxative and diuretic abuse
XS exercise

93

age of anorexia vs. bulimia

younger in anorexics

94

premorbid hx for bulimia

obesity before

95

mgmt of anorexia

1. hospitalization for dehydration/electro disturbances
2. psychotherapy
3. SSRI's

96

mgmt of bulimia-- need hospitalization

NOOOOOO
psychotherapy
SSRI's

97

tx of binge eating disorder

topiramate
psychotherapy: CBT, DBT, interpersonal

98

eating disorder not other wise specified

anorexia criteria-- BUT PERIOD NORMAL
anorexia criteria-- BUT WEIGHT NORMAL
compensatory behaviour-- BUT NORMAL AMOUNTS FOOD

99

step 1 drug choice for anorexia

mirtazapine-- since cures depression, and makes them gain weight

100

tx of choice in narcolepsy

modafinil
and forced naps during the day

101

specific features of narcolepsy

1. sleep attacks
2. cataplexy
3. hypnogogic and hypnopompic hallucinations
4. sleep paralysis

102

sleep attacks

episodes of IRRESISTIBLE sleepiness and feeling refreshed upon awakening

103

caaplexy

sudden loss of muscle tone

104

sleep paralysis

patient is AWAKE but unable to move-- typically occurs upon wakening

105

tx of sleep apnea

nasal CPAP
weight loss
corrective surgery
AVOID-- sedatives and alcohol which WORSEN condition

106

tx of insomnia

sleep hygiene techniques
non-benzo's

107

sexual identity

based on persons secondary SEXUAL characteristics

108

gender identity

sense of maleness or femaleness-- established by 3yo

109

gender role

based on EXTERNAL patterns of behaviour that reflect inner sense of gender identity

110

sexual orientation

choice of love

111

nb thing about patient with SUICIDAL IDEATION

take them all seriously and HOSPITALIZE the patient

112

impotence tx

EXCLUDE medical or medication causes
psychotherapy
couples sexual therapy

113

premature ejaculation

1. psychotherapy
2. behavioural modification-- stop and go, squeeze
3. SSRI's

114

genitopelvic pain disorder

= dyspareunia,
tx- psychotherapy

115

penetration disorder

= vagnismus-- involuntary constriction of outer third of vagina preventing penile insertion

116

paraphilic disorders

RECURRENT sexual arousing, mc in men, focusing on HUMILIATION, nonconsenting partners or use f non living objects, must occur for GREATER than 6 months and cause distress and poor level functioning

117

exhibitionism

recurrent urge to expose oneself to strangers

118

fetishism

recurrent use of non living objects to achieve sexual pleasure

119

masochism

recurrent urge or behaviour in HUMILIATING acts

120

sadism

recurrent urge or behaviour involving physical or psychological suffering of victim is exciting

121

transvestic fetishism

recurrent urge or behaviour in cross dressing

122

frotteurism

rubbing, usually ones pelvis or erect penis against a nonconsenting person for sexual gratification

123

tx of paraphilias

psychotherapy
behavioural modification
antiandrogens or SSRIs to decrease sexual drive

124

gender dysphoria

gender identity disorder-- persistent discomfort and sense of inappropriateness regarding patients assigned sex

125

mental retardation = intellectual disability

DEFECTIVE intellectural function AND SOCIAL adaptive functioning

126

tx for intellectual disability

GENETIC COUNSELING

127

autism spectrum disorders has replaced

autim, retts, aspergers

128

age of autism

3yo

129

timing with ADHD

GREATER than 6 months before the age of 7

130

2 areas dx of ADHD

HOME and SCHOOL

131

FIRST LINE TX ADHD-- STEP 2CK

atomoxetine (since side effects of other tx)

132

oppositional defiant

argue and lose temper
problems with AUTHORITY
DO NOT BREAK RULES

133

tx oppositional defiant

less oppositional behaviour and clinical mgmt. skills for parents

134

conduct disorder

less than 18yo,
persistently break rules, bully, cruelty, crimes, vandalism

135

tx conduct disorder

behavioural intervention-- rewards for prosocial and nonaggressive behaviour

aggression--> antipsychotic

136

DMDD= disruptive mood dysregulation disorder AGE

boys 6-10yo, NOT BEFORE 6 or AFTER 10yo

137

more likely to develop with DMDD...

bipolar
depression
anxiety

138

DMDD symptoms

OUTBURSTS of anger
SADNESS in between,
occurring every day--noticeable to others, out of proportion; NEVER SYMPTOM FREE FOR >3MONTHS

139

tx DMDD

individual therapy
may need meds for specific symptoms