Psychiatry Flashcards
(200 cards)
1
Q
Pt intentially produce SS for the purpose of assuming the “sick role”. Dx?
A
Factitious disorder.
2
Q
Pt intentially produce SS for the purpose of secondary gain (drugs, avoiding work, financial gain, etc.). Dx?
A
Malingering.
3
Q
Pt reports motor or sensory neurologic deficits that are incompatible with recognized neurological diseases. Dx?
A
Conversion disorder.
4
Q
Excessive preoccupation with having a serious illness with few or no Sx and negative workups. Dx?
A
Illness anxiety disorder.
5
Q
Excess anxiety about ≥1 unexplained symptoms that the patient experiences. Dx?
A
Somatic symptom disorder.
6
Q
Paranoid personality disorder Sx?
A
Suspicious
Distrustful
Hypervigilant
7
Q
Schizoid pesonality disrder Sx?
A
Loner
Detached
Unemotional
8
Q
Schizotypal personality disorder Sx?
A
Eccentric
Odd thoughts, perceptions, behavior
9
Q
Antisocial personality disorder Sx?
A
Disregard/violate rights of others
10
Q
Borderline personality disorder Sx?
A
Chaotic relationships Sensitive to abandonment Labile mood Impulsive Inner emptiness Self-harm
11
Q
Histrionic personality disoder Sx?
A
Dramatic
Superficial
Attention-seeking
12
Q
Narcissistic personality disorder Sx?
A
Grandiosity
Entitlement
Lack of empathy
13
Q
Avoidant personality disorder Sx?
A
Avoidance due to fears of criticism/rejxn
14
Q
Dependent personality disorder Sx?
A
Submissie
Clingy
Needs to be cared for
15
Q
OCD personality disorder Sx?
A
Rigid, controlling, perfectionist
16
Q
Neuroleptic malignant syndrome is mediated by dysfxn of what neurotransmitter?
A
Dopamine. D2 receptor antagonism results in movement issues, autonomic instability, confusion, and fever.
17
Q
Pt being treated for psychosis with muscle rigidity, AMS, and blood pressure issues who also has a high fever. Dx?
A
Neuroleptic malignant syndrome
18
Q
Elderly woman with fluctuating disturbances in behavior. She has a fever and was recently placed on antibiotics for “some kind of infxn” says her son. Dx?
A
Delirium. Mood changes, anxiety, agitation, and sleep disturbances are classic.
19
Q
What are SE of electroconvulsive therapy?
A
Anterograde and retrograde amnesia.
20
Q
Electroconvulsive therapy indicated for?
A
Major depressive episode
Bipolar depression
Bipolar mania
Catatonia
21
Q
20s female presents with abd bloating, HA, fatigue, and mood swings. She says they last about a week and then subside. She has had these cyclically for years. Hx of depression. Denies any depression Sx now or suicidal thoughts. Dx?
A
Premenstrual dysphoric disorder (PMDD).
22
Q
Next step in management of a Pt. with symptoms of premenstrual dysphoric disorder?
A
Menstrual diary. These determine relationship of symptoms to menstrual cycle phase.
23
Q
Clozapine indications?
A
Rx-resistant schizophrenia and schizoaffective disorder
24
Q
Clozapine SE?
A
Neutropenia Agranulocytosis rarely - Pts. required to be part of registry to monitor neutrophil counts before dispensing drugs.
25
Amantadine indications?
Parkinsonism. It is a dopaminergic agent.
26
Benztropine indications?
Acute dystonia. Has strong anticholinergic properties.
27
What is akathisia?
Restlessness.
a = without
kathazein = sitting
28
Abrupt discontinuation of benzos can result in?
Withdrawal symptoms within 1-2 days. Sx include seizures, psychosis, tremors, insomnia, anxiety. This is potentially life threatening.
29
An elderly female reports decreased total sleep time, more waking at night, and sleepiness earlier in the evening with earlier morning awakening, and a need to take naps during the day. Dx?
Normal age-related sleep changes. Do not prescribe benzos or nonbenzo hypnotics (zolpidem) for these normal changes. Unless the Pt. experiences significant impairment in activities of daily living/cognition, no workup/meds are necessary.
30
Advantage of bupropion?
No sexual SE or weight gain.
31
SE of bupropion?
Can worsen anxiety
32
Rx for panic disorder?
CBT
| SSRI
33
Rx for agoraphobia?
CBT
| SSRI
34
Antipsychotics lead to infertility how?
Blocking of dopamine leads to hyperprolactinemia which causes galactorrhea, menstrual irregularities, and infertility.
35
Antipsychotics with highest potential to cause infertility?
```
Haldol
Fluphenazine
Risperidone
Paliperidone (a risperidone metabolite)
```
36
Dx of MDD requires?
```
5/9 of SIGECAPS:
Sleep changes
Interest deficit
Guilt
Energy deficit
Concentration deficit
Appetite changes
Psychomotor changes
Suicidal
```
37
MDD Rx?
Psychotherapy
| Antidepressants
38
MDD patients who fail first-line antidepressants might benefit from what?
Another first line medication in a different class (eg bupropion from an SSRI, etc.)
39
SNRI names?
Venlafaxine
Desvenlafaxine
Duloxetine
40
NDRI name?
Bupropion
41
MAOI names?
Phenelzine
| Trancylcpromine
42
Body dysmorphic disorder Sx?
Preoccupation with ≥1 perceived physical defects.
| Defects not observable or are only slight to others.
43
Body dysmorphic disorder Rx?
SSRI
| CBT
44
Pediatric depression can present how?
Irritability rather than mood depression
45
Appropriate Rx for pediatric depression?
Psychotherapy and/or SSRIs (fluoxetine is DOC).
46
Within what time period would delerium tremens set in?
48-96 hours after last drink. Withdrawal Sx may begin within 6 hours, but severe w/d not until 2 days or so after.
47
Sx of delerium tremens?
```
Confusion/agitation
Fever
Tachycardia
HTN
Diaphoresis
Hallucinations
Fatal in 5% of cases
```
48
Any time a patient has a life altering event like stroke, cancer, etc. is depression normal?
No and it should be treated with antidepressants and/or psychotherapy.
49
Due to risk of agranulocytosis, what antipsychotic is reserved for pts who failed 2 other antipsychotics?
Clozapine.
50
First-line in psychosis?
Second-gen antipsychotics due to lower extrapyramidal SE/tarditive dyskinesia (Quetiapine, olanzapine, ziprasidone, ariprazole, risperidone).
51
Greatest RF for suicide?
Prior attempt.
52
First-line Rx for alcohol use disorder?
Naltrexone, a mu-opioid receptor antagonist OR
Acamprosate, a glutamate modulator.
Both used to curb cravings.
53
Contraindications to naltrexone in alcohol use disorder?
Opioid dependence. Can precipitate withdrawal.
54
Contraindications of acamprosate?
Renal failure.
55
Pt with psychosis and delusions has failed Rx with 2 other second-gen antipsychotics. What is next step in management?
Clozapine. Used in failed attempts to control with 2 other antipsychotics. Risk of agranulocytosis.
56
Pervasive pattern of argumentative and defiant behavior toward authority figures, but not so far as to violate the basic rights of others. Dx?
Oppositional defiant disorder. Pattern of angry/irritable mood, argumentative/defiant, or vindictiveness for ≥6months. Blames others for own mistakes, easily annoyed.
57
Rx for Oppositional defiant disorder?
Psychotherapy (anger management, social skills training). No meds, unless comorbid ADHD.
58
Pt. on antipsychotics with sudden, sustained contraction of neck, mouth, tongue, and eye muscles. Dx?
Acute dystonia.
59
Acute dystonia Rx?
Benztropine
| Diphenhydramine
60
Pt on antipsychotics with restlessness, inability to sit still. Dx?
Akathisia.
61
Akathisia Rx?
Beta blocker (propanolol)
Benzo
Benztropine
62
Antipsychotic induced parkinsonianism Rx?
Benztropine
| Amantadine
63
Gradual onset dyskinesia of mouth, face, trunk, extremities after several months of antipsychotic Rx. Dx?
Tarditive dyskinesia.
64
Tarditive dyskinesia Rx?
Valbenazine.
65
Denial?
Failure to accept disturbing aspect of reality
66
Displacement?
Transfer of feelings/impulses toward safer/more acceptable person/situation (person with new cancer Dx becomes more concerned about dying 90yo mother and ignores themselves)
67
Rationalization?
Justify/excuse behaviors rather than ackowledging the true motives, significance, or connsequences
68
Rxn formation?
Transforming an unacceptable feeling/impulse into its extreme opposite (pt with new cancer Dx with fear of dying now suddenly is fearless and super optomistic about a morbid diagnosis)
69
First-line Rx for an acute bipolar depressive episode (eg a major depressive episode during bipolar disorder)?
2nd gen antipsychotics (quetiapine and lurasidone) or lamotrigine (anticonvulsant)
70
SSRI given to pt with Hx of mania can lead to?
Precipitation of mania.
71
Postpartum depression Rx?
Antidepressants (SSRI)
| Psychotherapy
72
CBT primary indications?
```
Depression
General anxiety disorder
PTSD
Panic disorder
OCD
Eating disorder
Negative thought patterns
```
73
Psychodynamic psychotherapy primary indications?
Personality disorders
74
Motivational interviewing indicated for?
Substance use disorder (nonjudgemental, enhances motivation)
75
Dialectical behavioral therapy indication?
Borderline personality disorder. Emproves emotion regulation, distress tolerance, mindfulness, reduces self harm.
76
Biofeedback therapy indications?
Pain disorders
77
Pt presents with blank stare, not speaking, and is motionless. He has Hx of depression and psychosis and delusions. He resists efforts to move his limbs. Dx?
Catatonia. Characterized by immobility or excessive purposeless activity. Mutism and stupor are classic. Rx: benzos and ECT
78
Catatonia Rx?
Benzos
| ECT
79
First-line maintenance Rx for bipolar disorder?
Lithium
Valproate
Quetiapine
Lamotrigine
80
Pt taking antipsychotic becomes confused with high fever and cannot move his body. BP is low and he sweats profusely. Dx?
Neuroleptic malignant syndrome.
81
Rx for Neuroleptic malignant syndrome?
Stop antipsychotics
Start dopamine agents
Supportive care (cooling, hydration)
Dantrolene or bromocriptine if refractory
82
Binge-eating disorder Sx?
Recurrent binge eating with lack of control, but NO compensatory behaviors (eg vomiting, diuretic abuse)
83
Anorexia nervosa Sx?
Significantly low weight (BMI<18.5).
Fear of gaining weight.
Distorted body image.
Subtypes: binge/purge, restricting
84
Bulimia nervosa Sx?
Normal or high BMI (>18.5)
Recurrent binges
Compensatory behavior to prevent weight gain (vomiting/exercise)
Worry about shape/weight
85
Narcolepsy with excessive daytime somnolence Rx?
Modafinil - nonamphetamine stimulant.
86
When a patient does not acknowledge the problem (drinking, etc.), the physician's tole is to?
Suggest that the abuse may play a role in the problem.
87
Panic disorder acute Rx?
Benzos.
88
Panic disorder long-term Rx?
Antidepressants
| CBT
89
Dx timeframe: brief psychotic disorder?
Up to 1 month
90
Dx timeframe: Schizophreniform disorder?
1 months to 6 months (no fxnal decline required as in schizophrenia)
91
Dx timeframe: Schizophrenia?
≥6months (requires fxnal decline)
92
Schizophrenia-like symptoms with concurrent mood disorder?
Schizoaffective disorder.
93
Delusional disorder Sx?
1 or more delusions for >1 month, but WITHOUT other psychotic symptoms and normal fxn aside from delusions
94
Obessions and compulsions in OCD are defined by?
Obsessions: recurrent/intrusive thoughts
Compulsions: Repeated behaviors/mental acts in response to obessions
95
OCD Rx?
SSRI
| CBT (exposure and response prevention)
96
Pt is increasingly restless with increasing dosage of his antipsychotic meds. His hallucinations are gone. Dx?
Akathisia due to meds. Rx: give beta blocker (propanolol 1st line) and reduce the antipsychotic dose
97
Pt with fear of heights who cannot even walk up stairs or take elevators finds relief with benzos in acute setting. What other Rx might help?
CBT with exposure therapy
98
Lithium toxicity Sx?
Acute: GI (NVD)
Chronic: Confusion, agitation, ataxia, tremors, fasciculations
99
Lithium drug interactions leading to toxicity?
Thiazides
NSAIDs
ACEI
Some ABx
100
Management of severe lithium OD?
In severe cases, hemodialysis may be needed.
101
Adjustment disorder Sx?
Impaired fxning after a change or secondary to a change in one's life
102
Oppositional defiant disorder Sx?
Angry
Argumentative, Vindictive
for 6 months or more
103
Separation anxiety disorder Sx?
Extreme, persistent anxiety with separation. Excessive worry about losing parents, whomever.
Physical Sx result (HA, stomach ache, etc.)
104
MC SE of Olanzapine?
Weight gain
| Sedation
105
MC SE of Clozapine?
Leukopenia and agranulocytosis.
106
Nephrogenic DI SE of what drug?
Lithium
107
Onset of postpartum depression?
4-6 weeks, but can occur up to a year after birth
108
Onset postpartum blues (not depression)?
2-3 days resolving in 2 weeks.
109
Onset postpartum psychosis?
Variable: days - weeks
110
Postpartum depression Rx?
Antidepressants
| Psychotherapy
111
Conversion disorder Sx?
Sudden onset of neurological Sx without a recognizable neurological condition (lady loses eyesight after seeing child drown, but PE is normal)
112
Another name for illness anxiety disorder?
Hypocondriasis
113
Rx of MDD with psychotic features (delusion/hallucinations)?
Combo antidepressant and antipsychotic OR ECT
114
What psychiatric symptoms are NOT present in delusional disorder?
Mood symptoms (depression, mania)
115
Major depressive mood or manic episode concurrent with schizophrenia symptoms. Dx?
Schizoaffective disorder.
116
How can bipolar with psychotic features, schizophrenia, and schizoaffective disorder be differentiated?
Bipolar and MDD with psychotic features: only presents with psychosis during mood episodes. Schizoaffective: has significant mood symptoms with psychotic Sx and psychotic Sx without mood sx
Schizophrenia: mood symptoms are brief
117
Complications of anorexia nervosa?
```
Hypothermia
Malnutrition
Dehydraton
Orthostasis
Arrhythmia (brady esp)
Refeeding syndrome
```
118
When does an anorexic patient require hospitalization?
```
When they become medically unstable due to their condition. Complications include:
Hypothermia
Malnutrition
Dehydration
Orthostasis
Arrythmias (bradycardia)
Refeeding syndrome
```
119
SAD PERSONS acronym?
```
Suicidality assessment:
Sex
Age
Depression
Previous attempt
EtOH/drugs
Rational thought (psychotic?)
Support
Organized plan
No spouse/GF/BF
Sickness or injury
```
120
All depressed patients should be screened for?
Suicidal ideation, intent, plan.
121
Active suicidality requires what two things?
Intent and plan. They often need to be hospitalized.
122
Pts with a single episode of MDD should continue antidepressants for how long?
6 months following the acute response.
123
Pts with recurrent, chronic, severe episodes of depression should continue antibiotics for how long?
1-3 years or indefinitely.
124
MDD effects on the hypothalamic-pituitary-adrenal axis?
Hyperactive HPA lead to increased cortisol levels.
125
A pt with elevated mood and psychotic features likely has?
Mania. Psychosis only occurs in mania, rather than hypomania where no psychosis occurs.
126
Mania vs hypomania?
Hypomania does not lead to impairment or hospitalization like mania.
127
Bipolar 1 Sx?
Mania (impairment) with depressive episodes. Depression not required for Dx.
128
Bipolar 2 Sx?
Hypomania (nonimpaired) with ≥1 major depressive episode.
129
Cyclothymic disorder Sx?
≥2 years fluctuating, mild hypomania and depression Sx that do not reach criteria for hypomanic or major depressive episodes
130
DIGFAST acronym?
```
Manic episode criteria - 3+ of following:
Distractibility
Impulsivity
Grandiosity
Flight of ideas
Activity
Sleep
Talkativeness/pressured speech
```
131
Impaired social communication and interactions and restricted/repetitive patterns of behavior in a 2-3 year old may indicate?
Autism.
132
Autism Rx?
```
Early Dx/intervention
Multimodal Rx (speech, behavioral, educational services)
Drugs if psych comorbidities
```
133
Survivors of sexual assault are at increased risk for?
PTSD
Depression
Suicidality and attempts
134
An elderly male with loss of interest in food and activities also presents with auditory hallucinations. He is losing weight. He has poor sleep and ruminates on prior events like treating his brother poorly when younger. A trial of SSRIs has failed to manage the Sx. Dx and Rx?
Major depressive disorder with psychotic symptoms. This patient failed the SSRI and is a candidate for ECT. Antidepressants take 6-8 weeks to respond and must be combined with antipsychotic drugs to treat MDD with psychotic features. ECT is appropriate in a patient with severe depression who is not eating.
135
Social anxiety disorder Sx?
Social phobia. Marked anxiety about ≥1 social situation for ≥6 months. Fear scrutiny of others.
136
Social anxiety disorder Rx?
SSRI/SNRI
CBT
ß-blocker or benzo for performance-only subtype
137
Hoarding disorder Rx?
CBT
| SSRIs have limited efficacy.
138
SE of TCAs?
AMS
Sz
Cardiac conduction delay (QRS duration>100msec associated with increased risk arrhythmias)
Anticholinergic Fx
139
Panic disorder key idea
Unexpected panic attacks
140
Generalized anxiety disorder key idea
Chronic multiple worries (work, relationship, kids, etc.)
141
Social anxiety disorder key idea
Fear of scrutiny
142
Dysthymia key idea?
(aka persistent depressive disorder) Characterized by chronic depressed mood
143
Dysthymia definition
Persistent depressive mood with ≥2 other depressive symptoms lasting ≥2 years.
144
Dysthymia differs from MDD how?
Dysthymia never reaches criteria for MDD. MDD requires depressed mood + 5/9 SIGECAPS criteria for Dx.
145
Second generation antipsychotic MOA?
Serotonin 2A and dopamine D2 receptor antagonism
146
Common SE of risperidone?
Prolactin elevation
| Some alpha and histamine agonist activity
147
What antidepressant inhibits reuptake of NE and DA?
Bupropion
148
Venlafaxine MOA/class?
SNRI
149
TCA MOA?
Like SNRI, Serotonin and NE reuptake inhibition.
150
Define major depressive episode
≥2 weeks depressed mood with associated symptoms (anhedonia, sleep issues, etc.)
151
Additional benefits of bupropion?
Mild stimulant effects (for fatigue)
Smoking cessation
Helps with weight loss
NO sexual SE
152
Bupropion contras
SZ
| Eating disorders
153
Sudden onset psychosis in a child/adolescent would stim a search for?
Reversible conditions (medical issues/substance abuse).
154
Common medical causes of psychosis in children are?
```
SLE
Thyroiditis
Metabolic disorders
Electrolyte disorders
CNS infxn
Epilepsy
```
155
Best statement for nonadherence in Pts?
Empathic/nonjudgemental
Say something confirming/understanding
"It can be hard..."
156
REM sleep behavior disorder basic idea?
Dream enactment due to muscle atonia absence (kicking stuff, violent movements in bed, injury during sleep)
- awaken immediately (no latency as in terrors)
- recall dreams (unlike terrors)
157
REM sleep behavior disorder may indicate what in elderly?
Neurodegeneration
158
Nightmare disorder basic idea?
Vivid recall of disturbing dream content
159
Nocturnal seizures basic idea?
SZ in kids at night - typical Sz activity only they occur at night
160
Restless legs syndrome basic idea?
Urges to move legs - sleep distrubances - involuntary, jerking of legs during sleep, but no dream enactment
161
Sleep terrors basic idea?
Non-REM sleep arousal disorder in kids
- period of confusion before becoming alert
- no recall of dreams
162
Sleepwalking basic idea?
Non-REM sleep arousal disorder
| - similar to terrors in that no recall of dream and there is confusion period
163
Borderline personality disorder Rx?
Psychotherapy and pharmacotherapy to target mood issues/psychosis
164
Bipolar 1 basic idea?
Full mania with or without major depressive episodes
165
Bipolar 2 basic idea?
Hypomanic episodes (nonimpairment of life) with major depressive episodes
166
Avoidant vs dependent personality disorder behaviors?
Avoidance of relationships due to fear of criticism/rejection vs Submissive and clingyness - requiring to be cared for rather than overtly fearing rejection as in avoidant
167
First approach to Pts who experience a traumatic incident and have early signs of acute stress disorder?
Educate on range of reactions to normalize experience
168
Acute stress disorder definition?
Trauma leads to ≥3 days but less than 1 month of intrusive memories, nightmares, flashbacks with intense rxns.
Amnesia, detachment, avoidance can occur
169
Acute stress disorder treatment?
Trauma-focused CBT
Drugs for sleep/anxiety (no SSRIs until PTSD develops)
Monitor for PTSD development
170
PTSD treatment?
SSRIs are first line
171
Panic disorder main idea?
Unexpected panic attacks (differ from specific triggered attacks as in social anciety disorder/phobia)
Fear of future attacks
Avoidant behavior
172
What psych med is contra'd in Sz, anorexia, bulemia?
Bupropion. It enhances Sz risk and worsens weight loss.
173
60s female presents with anxiety about her children leaving for college has been drinking alcohol to fall asleep each night. Labs reveal elevated AST/ALT and macrocytosis. Likely Dx?
Alcohol use disorder. Women who consume >7 drinks/wk or >3/day or men who consume >14/wk or >4/day are within the definition. The elevated LFTs and macrocytosis are incidental findings that raise suspicion for alcohol abuse.
174
What factor delineates normal aging memory issues from dementia?
Cognitive deficits that interfere with everyday activity. Dementia results in fxnal impairments that necessitate assistance. e.g. cannot operate appliances, loses interest in socializing, gets lost for hours in familiar areas
175
What is the key to somatic symptom disorder management?
Frequent, regularly scheduled visits to PC. This will minimize unnecessary testing, interventions, and referrals and will help ID psychological stressors by forming a strong Pt-Dr bond.
176
Worrisome SE of varenicline?
Mood changes
Suicidality
CV events in those with previous CV Hx
177
Pt with prior bulemia Hx asking for smoking cessation assistance. He tried verenicline, but had "weird side effects". What is best management?
Nicotine patches or nicotine replacement therapy
178
Pt with prior bulemia Hx asking for smoking cessation assistance. He tried verenicline, but had "weird side effects". What is best management?
Nicotine patches or nicotine replacement therapy. Bupropion and varenicline are other effective Rx, but are contra'd in this pt.
179
Biggest factor that differentiates a normal stress reaction vs a pathologic one?
Normal stress rxns have an absence of fxnal impairment.
180
2nd generation antipsychotics lead to what SE?
Metabolic syndrome:
Weight gain
Hyperglycemia (including new-onset DM)
Dyslipidemia
181
Monitoring guidelines for 2nd generation antipsychotics?
BMI
Fasting glucose/lipids
BP
Waist circumference
182
What is paradoxical agitation?
Agitation (hence, paradoxical) that occurs about 1 hour after administration of benzos. Typically occurs in elderly.
183
Generalized anxiety disorder DSM-5 criteria?
```
Excessive worry about multiple issues ≥6months.
3 or more:
Restless
Fatigue
Concentration issues
Irritable
Muscle tension
Sleep issues
```
184
Rx for Generalized anxiety disorder?
CBT
| SSRIs or SNRIs
185
Pt has sustained contrxn of neck muscles and his face appears to have an odd grin. He is new "crazy meds". Rx?
Acute dystonia requires Benztropine or diphenhydramine
186
Pt is incredibly restless and cannot sit still. He is on new "crazy meds". Rx?
Akathisia requires Propanolol 1st. Benzodiazepines or benztropine next.
187
Pt. taking new "crazy meds" complains of tremor and rigidity. Rx?
Parkinsonianism requires benztropine or amantadine (antiviral and antiparkansonian drug).
188
Pt. taking several months of "crazy meds" arrives at the office with trouble moving his mouth, face, trunk, and his arms. He says the drugs took the voices away, but these movement problems make eating real tough. Rx?
Valbenazine. Tarditive dyskinesia occurs slowly over many months (usually >6) of Rx with antipsychotic meds.
189
Time periods for acute stress disorder vs PTSD?
ASD <1 month
| PTSD >1 month
190
Phencyclidine (PCP) can pop false positive on a standard drug test with exposure to what common drugs?
```
Dextromethorphan
Diphenhydramine
Doxylamine
Ketamine
Tramadol
Venlafaxine
```
191
1st line mood stabilizers for bipolar disorders?
Lithium
| Valproate
192
2nd line mood stabilizers in bipolar disorders?
Quetiapine
| Lamotrigine
193
What must be considered before giving mood stabilizers for bipolar disorders?
Lithium is contra'd in renal impairment. It is excreted by the kidneys unchanged. Valproate should be used if Cr elevated.
194
What labs are to be checked before mood stabilizers given in new onset bipolar disorder?
Creatinine to evaluate for renal impairment. Lithium cannot be used in renal impairment as it will build to toxic levels.
195
SE of valproate?
Hepatotoxicity
| Thrombocytopenia
196
Labs checked in long-term valproate use?
LFTs
| CBC (platelet counts)
197
What is considered an "adequate trial" of an antidepressant?
≥6 weeks with adequate dose of drug
198
Appropriate management of depression in a patient who has been taking an appropriately dosed SSRI for ≥6 weeks?
Switch to another SSRI or another first-line antidepressant (bupropion, mirtazapine, or a serotonin modulator like vilazodone)
199
When are TCAs and MAOIs considered in depression?
After failure of several trials of other antidepressants. These drugs have lower tolerability by patients and are more toxic.
200
What is required when switching from SSRIs to MAOIs?
2 week minimum washout period between stopping taking SSRI and starting to take MAOI. Fluoxetine requires 5 week washout as it has longer half life.
