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Psychiatry Flashcards

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1
Q

Attention-Deficit Hyperactivity Disorder (ADHD) (dg)

A

Before 12yo has ≥5 sympt from each category for ≥6mo in ≥2 settings (home/school/…) lead to signif social + academ impair

  • Inatt: poor att span, poor att to details/careless mistakes, diff follow instruc/finish task, forgetful, easy distract*
  • Hyperactiv/Impulsiv: fidget, leave seat in class, run around, cant play quiet, talk excess, dont wait his turn, interrupt others
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2
Q

ADHD (PE, ttt)

A

Persistent excessive inatt (esp girls) +/or hyperactiv/impulsiv (esp boys)
Betw/ 3-13yo; often familial

ttt: #1 behav modif, then pharmaco
- Psychostimulant: methylphenidate, dextroamphetamine; (side eff: insomn, irritab, ↓appetite, tic↑, ↓growth)
- Nonstimulant (SSRI, nortriptyline, bupropion) and alpha2-agonist (clonidine) and atomoxetine

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3
Q

Autism Spectrum Disorder (PE)

A

Esp boys; before 3yo
Wide variat* in IQ and severity (based on level of support needed)

AbNl/impair social interact* + communic + restrict activities/interests
Spoken language delay/absent
Stereotyp speech+behavior

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4
Q

Autism Spectrum Disorder (ttt)

A

Intensive special educat*
Behav manag
Symptom-targeted meds: neuroleptic if aggressive, SSRI for stereotyp behav
Family counseling!!!

Ass w/ Rett sd, fragile X sd, tuberous sclerosis

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5
Q

Disruptive behavioral disorders

A

Esp men/boys; Hx of abuse; ttt ptt and family

-Oppositional defiant disorder: negativistic defiant disobedient hostile behavior tow/ authority; ≥6mo
May progr to conduct dso

-Conduct disorder: persist violating basic rights of others, societal norms/rules; ≥1y. May be aggress (rape, cruelty) or nonaggress (steal, lie, annoy)
May progr to antisocial personality dso in adult

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6
Q

Intellectual developmental disorder

A

At <18yo; IQ<70 w/ def in adaptive fct* (hygiene, social skills)
Ass w/ male, chrom abNl, congen inf, teratogens, alcoh/drugs, inborn metab errors

Mild (IQ 50-70); mod (35-49); sev (20-34); profound (<20)
ttt: 1* prevent* (educat public + prenatal screen)
Family counseling/support, speech/lang therapy, physical therapy, behav interv, assist, social skills training

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7
Q

Tourette syndrome

A

Esp boys/men, starts <18yo; genetic predispo
Ass w/ ADHD, learning dso, OCD
Multiple motor tics + vocal tics, recurr for >1y
+ social/occupational impairment

ttt: dopamine recept antag (haloperidol) or clonidine
Behav therapy + counseling
CI stimulants

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8
Q

Schizophrenia (epidemiology, ttt)

A

Psychotic sympt + disorganizat* + negative sympt
1% pop; M=W; peak at 18-25yo in M and 25-35 in W
↑R if 1st relative also
Suicide: 50% attempt; 10% successful

ttt: antipsychotics + long-term follow-up
Supportive psychottt, train social skills, illness educat*
Atyp antipsy esp for negative sympt

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9
Q

Schizophrenia (PE)

A

≥2 sympt for ≥6mo w/ social/occupat dysfct*

  • Positive sympt: hallucin, delus*, disorg speech, bizarre behav, thought dso
  • Negative sympt: flat affect, ↓emotion, poor speech, lack of purposeful act*, anhedonia
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10
Q

Differential diagnosis of psychosis

A
  • Brief psychotic disorder: >1d and <1mo
  • Schizophreniform disorder: >1mo and <6mo
  • Schizophrenia: >6mo
  • Schizoaffective disorder: schizo + major affective dso (major depr dso or bipol dso)
  • Schizotypal perso dso: magical thinking
  • Schizoid perso dso: loner
  • Delusional dso: persist nonbizarre fixed delus, unaffected fct
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11
Q

Typical antipsychotics

A

For psychotic disorders, acute agitat*, acute mania, Tourette, esp positive sympt of schizo

  • High potency (haloperidol, fluphenazine): EPS > anticholinergic sympt; ↑QTc; TdP; neuroleptic malignant sd
  • Low potency (thioridazine, chlorpromazine): anticholinergic sympt > EPS; orthostatic hypoTN; retinal pigm (thiorid)
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12
Q

Atypical antipsychotics

A 
Risperidone, quetiapine, olanzapine, ziprasidone, aripiprazole, clozapine
#1 ttt for schizo (↓side eff)
Clozapine: sev ttt resistance

↑weight, DM2, somnolence, ↑QTc
Clozapine: agranulocytosis (CBC/wk for 6mo)

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13
Q

Extrapyramidal syndrome

A
  • 4h: acute dystonia (ttt: anticholinergic)
  • 4d: dyskinesia (ttt: anticholinergic or dopamine agonist; ↓or stop neuroleptic)
  • 4wks: akathisia (ttt: ↓neuroleptic, give B⊖; +/- benzo or anticholin)
  • 4mo: tardive dyskinesia (ttt: ↓/stop neuroleptic; clozapine; other meds)
  • Anytime: neuroleptic malignant syndrome (ttt: stop med; support in ICU; dantrolene or bromocriptine)
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14
Q

Generalized anxiety disorder

A

Uncontrol excessive anxiety; multiple activities
Signif impairment/distress; M/F=1:2; early 20s

Anx most days for ≥6mo + ≥3 somatic sympt
ttt: short-term (benzo immed then taper bcz !tolerance)
Long-term: lifestyle, psychotherapy, meds (SSRI #1, venlafaxine, buspirone)

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15
Q

Panic disorder (PE)

A

Recurr unexpect panic attacks; W>M; ~25yo
+/- agoraphobia
≥1mo concern of having attacks

Intense fear/discomf + ≥4 sympt abrupt/peak in 10min (tachypn, palpit, chest pain, diaphor, N, trembl, dizzy, going crazy, deperson, hot flashes)

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16
Q

Panic disorder (ttt)

A

Short-term: benzo (immed) then taper bcz tolerance
Long-term: CBT, meds (SSRI #1, TCAs)
If ass w/ agoraphobia: ttt it also

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17
Q

SSRIs

A

Fluoxetine, sertraline, paroxetine, citalopram, escitalopram
GAD, OCD, panic disorder, depress*, anxiety

Side eff: N, GI, somnol, sex dysfct, agitat*, insomn, tremor
!!!Not w/ MAOIs (dev serotonin sd)

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18
Q

Buspirone and B⊖

A

-Buspirone: GAD, social phobia
No tolerance, dependance or withdrawal
Side eff: seizures if chronic; !!!Not w/ MAOIs

-B⊖: prior to phobic disorder
Side eff: bradycardia, hypoTN

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19
Q

Benzodiazepines

A

Anxiety, insomnia, alcohol withdrawal, M spasm, night terrors, sleepwalking

Side eff: ↓sleep durat; abuse/tolerance/dependence; disinhibit in young/old; confus*

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20
Q

Phobias (social and specific)

A

-Social: specific (speaking, urinating) or general (interact*)
Often ado

-Specific: feared object/situat*
Often childhood

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21
Q

Phobias (PE, ttt)

A

Excessive fear + avoidance
Signif distress/impairment and ⊕insight

ttt: social ph (CBT, SSRI, low-dose benzo, B⊖)
Specific ph (CBT+desensitizat*, support, family psychottt)
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22
Q

Obsessive-compulsive disorder (OCD)

A

Obsess* and/or compuls; signif distress/dysfct
Late ado or early adult; W=M

Obsess: persist unwant intrusive idea/impulse: marked anxiety/distress
Compuls: repeat mental act/behav to neutralize

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23
Q

OCD (#dg, ttt)

A 
OCD: ⊕insight + wants to be ttt
#OCPD = personality dso: do not recognize the prob

ttt: SSRIs #1, CBT (desensitizat), educat

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24
Q

Body dysmorphic disorder

A 
Preoccupat* w/ imagined or slight physical defects
Imperceptible to others
Signif distress/impairment
Obsess* + repetitive behav
ttt: SSRIs
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25
Post-Traumatic Stress Disorder (PTSD)
Signif distress/impairment Extreme life-threat traumatic event: direct expo, witnessing, indirect in close friend 4 sympt clusters for >1mo Intrus* (reexperience), avoidance, negative alterat* in mood/cognit*, changes in arousal/reactivity If >3d to <1mo: acute stress dso
26
PTSD (ttt)
Short-term: B⊖, alpha2-agonists (for anxiety) | Long-term: meds (SSRIs #1, ... Avoid benzo), psychotherapy, support groups
27
Adjustment disorder
Signif distress after profound life change But r/o other mental dso 3mo after stressor; resolv in 6mo Anxiety, depressed mood, conduct; ↑R suicid ttt: supportive counsel
28
Dementia (Major neurocognitive disorder) (PE)
Progress ↓cognit* w/ global deficits; Nl conscious Esp Alzheimer or vascular dem Impaired cognit* in order: Amnesia, Aphasia, Apraxia, Agnosia Impaired executive fct*: plan, organize, abstract +/- personality, mood, behav changes
29
Dementia (dg, ttt)
Dg: Hx+PE, serial MMSE R/o treatable causes (labs, vitB12/B9, LFTs, UA, CT/MRI,...) ttt: environmental cues for daily life Cholinesterase inhib, family/ptt educat* + support Low-dose antipsychotics (if aggress) Avoid benzo
30
Delirium (PE)
Acute disturb conscious + altered cognit* Hours to days; esp child/elder/hospit ptt Wax/wane conscious + perceptual disturb (halluc, illus*, delus*); +/- anxiety, paranoid, stupor
31
Delirium (dg, ttt)
Dg: vitals, oximetry, glu, PE, neuro exam, labs, imagery Recent meds/drugs, prior episodes, organ failure, inf ttt: underl cause (often reversible), optimize environment, low-dose antipsychotics (agitat*/hall) +/- physical restraint
32
Major depressive disorder (dg)
≥1 episodes; M/F=1:2; esp mid-20s but in elder ↑w/ age Esp if stress or chronic illness; !!!suicide 5 subtypes: psychotic features, postpartum, atypical, seasonal, double depress* Dg: ≥2 weeks of depressed mood or anhedonia + ≥5 signs/sympt (sleep, interest, guilt, energy, concentrat*, appetite, psychomotor agitat*, suicidal)
33
Major depressive disorder (ttt)
- Meds: 2-6wks for effect; ttt for ≥6mo - Psychotherapy w/ meds - Phototherapy: seasonal depress* - Transcranial magnetic stimulation -ECT: if refractory, psychotic depress*, sev mania or suicidality 2-3/wks for 6-12ttt Relative CI: recent stroke/MI, intracranial mass, anesth R
34
Major depressive disorder (#dg)
- Mood dso due to a medical condition - Substance-induced mood disorder - Adjustment disorder w/ depressed mood (in 3mo of a stressor) - Normal bereavement (<6mo, max 1y) - Dysthymia (mild chronic depress* most of time for ≥2y)
35
Postpartum disorders
- PP blues: in 2wks pp; sad, moody, emot* lability; No thoughts ag bb - PP psychosis: 2-3wks pp; delus* + depress*; may have thoughts to hurt bb - PP depress*: 1-3mo pp; depress*, sleep disturb, anxiety; thoughts to hurt bb
36
Atypical antidepressants
Bupropion, mirtazapine, trazodone Depress*, anxiety Bup: seiz; so CI if seiz Hx or eating dso Mirta: ↑weight, sedat* Traz: sedat*, priapism
37
SNRIs
Venlafaxine, duloxetine Depress*, anxiety, chronic pain Venlaf: diastolic HTN
38
Tricyclic antidepressants
Nortriptylline, desipramine, amitriptylline, imipramine Depress*, anxiety, chronic pain, migraine, enuresis (imipr) Side eff: lethal if overdose (arrhyth) so monitor ICU x3-4d Anticholinergic eff
39
MAOIs
Phenelzine, tranylcypromine, selegiline Depress*, esp atypical HTN crisis if taken w/ ↑tyramine food Sexual dysfct*, orthostatic hypoTN, ↑weight
40
Bipolar disorder (types)
``` Types I (1%) and II (4%); M=W; ↑R if fam Hx ~20yo; ↑episodes w/ ↑age; !!! suicide ``` - BP I: ≥1 manic or mixed episode (+/- hospit) - BP II: ≥1 MDE and ≥1 hypomanic episode - Rapid cycling: ≥4 episodes (MDE/manic/mixed/hypomanic) in 1y - Cyclothymic: chronic less sev, alternate hypomania and moderate depress* for >2y
41
Bipolar disorder (PE, dg)
Distractibility, insomnia, grandiosity, flight of ideas, psychomotor agitat*, sexual indiscretions, talkativeness +/- psychotic features -Manic: ≥1wk persistent elevated expansive mood + 3 sympt; signif impairment R/o substance or medical condit* -Hypomanic: same but no impairment, no psychotic sympt, no hospit
42
Bipolar disorder (ttt)
BP mania: emergency (↑R for ptt and others) Acute ttt: antipsychotics, lithium, valproate Mainten ttt: mood stabilizers Benzo if refractory agitat* BP depress*: mood stabil first +/- antidepr !!! CI antidepr w/o mood stabilizer ECT if refractory
43
Lithium
``` #1 for acute mania Prophylaxis in BPD, ↓R suicide ``` Side eff: diabetes insipidus, tremor, ↑weight, hypothyr, GI, seiz, teratogen, acne Narrow therapeutic window Toxicity (>1.5mEq/L): ataxia, dysarthria, delirium, acute renal failure
44
Carbamazepine
#2 mood stabil; anticonvulsant; trigeminal neuralgia Side eff: N, rash, leukopenia, AV block, teratogen Rare: aplastic anemia, SJS
45
Valproic acid
Bipolar, anticonvulsant Side eff: GI, tremor, sedat*, alopecia, ↑weight, teratogen Rare: pancreatitis, thrombocytopenia, fatal hepatotoxicity, agranulocytosis
46
Lamotrigine
#2 mood stabil; anticonvulsant Side eff: blurred vis*, GI distress, SJS (so slowly ↑dose)
47
Personality disorders
Emotional + behavioral traits chronically rigid and maladaptive + social/occup impairment Stable + predictable Early adult Dg: ask abt attitudes, mood variability, activities, react* to stress; deny/diff changing behavior; refuse ttt ttt: psychotherapy (#1); meds if comorbid psychiatric ds
48
Cluster A (Weird)
- Paranoid: distrustful, suspicious, see other's motives as evil - Schizoid: isolated, detached, restricted emotional express* - Schizotypal: odd behavior/perceptions/appearance, magical thinking
49
Cluster B (Wild)
- Borderline: unstable mood/relationships/self-image, feel emptiness, impulsive, suicidal ideat*/self harm - Histrionic: excess emotional/attention seeking, sexual provocative, theatrical - Narcissistic: grandiose, need admirat*, lack empathy - Antisocial: violate others' rights/social norms/law, impulsive, lack remorse (must have Hx of conduct dso)
50
Cluster C (Worried)
- Obsessive-compulsive: preoccupied w/ perfectionism + order + control at expense of efficiency, doesnt feel probl - Avoidant: socially inhibited, rejection sensitive, fear of being disliked/ridiculed but desires friends/social interact* - Dependent: submissive, clingy, need to be taken care of, feel helpless, difficulty making decisions
51
Substance use disorders
``` Most subst (except caffeine); signif impairment Dg: 2 of 11 criteria in 1y Criteria grouped into: impaired control, social impairment, risky use, pharmacologic ``` Tolerance and withdrawal: not needed to make dg Severity of abuse: mild (2-3/11), mod (4-5/11), sev (>6) Check: urine+bld toxico screen, LFTs, serum EtOH
52
Alcohol use disorder (dg, complications)
``` Esp men (4:1); 21-34yo; ⊕fam Hx Dg: screen w/ CAGE (Cut down, Annoyed by criticism, Guilty, Eye opener); monitor vitals; LFTs, LDH, MCV ``` Compl: pancreatitis, liver ds, DT, hallucinosis, periph neurop, Wernicke/Korsakoff, FAS, aspirat* pneumonia, trauma, ..........
53
Alcohol use disorder (ttt)
``` R/o compl, correct e- Benzo taper (withdrawal sympt) Haloperidol (psychotic sympt) Multivitamins + B9 + B1 before glucose Anticonv (if seiz Hx) ``` For dependence: group therapy, disulfiram, naltrexone Long-term rehab therapy (AA)
54
Anorexia nervosa (RF, PE)
RF: female, ↓self-esteem, ↑socio-eco status Ass w/ OCD, MDD, anxiety, modeling, gymnastics, ballet, running Sev restrict KCal (fast or ↑exo) or binge+purge (vomit, laxat, diuret) Cachexia, BMI<18, lanugo, dry skin, bradyc, lethargy, hypoTN, cold intol, hypothermia
55
Anorexia nervosa (dg, ttt)
Dg: BMI, CBC, e-, endocrino, ECG, intense fear of ↑weight, psychiatric eval (comorbid) ttt: monitor KCal, hospit if necess Psychotherapy; ttt comorbid Ptt may resist ttt (not distressed by ds)
56
Medical complications of eating disorders
``` Constitutinal: cachexia, hypothermia, fatigue, e- Cardiac: arrhyth, sudden death, ... GI: dental eros*, abdo pain, ... GU: amenorrhea, nephrolithiasis Dermato: lanugo Hemato: leukopenia Neuro: seiz MSK: osteoporosis, stress fx ```
57
Bulimia nervosa
Esp women; ass w/ ↓self-esteem, mood dso, OCD Dg: ≥1wk for ≥3mo of episodes (binge eat + compensatory behav of purge or fast); Nl or overweight Dental enamel eros*, larg parotid, scars on dorsal hand Ptt distressed so easily ttt ttt: psychotherapy +/- antidepressants
58
Sexual changes with aging
Same interest in sex Men: need ↑stimulat* for longer period to reach orgasm, ↓intensity of orgasm, ↑refractory period Women: ↓estro, dry/thin vag, discomfort; ttt w/ HRT, estro vag suppo, vag creams
59
Paraphilic disorders
Preoccup w/ unusual sex fantasies/urges/behav for >6mo Signif impairment 8 disorders characterized by: disordered courtship, disordered preferences, pleasure in inflicting/receiving pain ttt: insight-oriented psychotherapy + behavioral therapy
60
Gender dysphoria (dg)
Strong persistent cross-gender identificat* Discomfort w/ assigned sex/gender role No intersexual disorders Men > Women; Hx of dressing like opposite sex, taking sex hormones, surg to reassign sex Psychiatric comorbidities
61
Gender dysphoria (ttt)
Educat* (culturally acceptable behav pattern) ttt comorbid Sex-reassign surg or hormonal ttt Psychotherapy
62
Sexual dysfunction
Prob in arousal, desire, orgasm, pain 30% of pop 1/3 biological; 1/3 psycholog ttt: dep on cause; sildenafil, bupropion; psychotherapy
63
Sleep disorders
1/3 of US adults; dyssomnia, insomnia RF: female, mental/medical dso, substance abuse, adv age Sleep hygiene: regular schedule, ↓caffeine, avoid naps, evening warm bath, bedroom (sleep/sex), exo early, relaxat*, avoid large meals
64
1* insomnia
30% pop; R/O physical/mental dso Nonrestorative sleep, diff initiate/maintain sleep; ≥3 times/wk for 1 month ttt: sleep hygiene (#1); meds (#2; for short period <2wks; diphenhydramine, zolpidem, zaleplon, trazodone)
65
1* hypersomnia
Excessive daytime sleepiness or nighttime sleep For >1mo R/O medical/mental dso, meds, poor sleep hygiene, insufficient sleep, narcolepsy ttt: stimulant meds (#1; amphetamines)
66
Narcolepsy
Young adult, <30yo; may be genetic Excess daytime somnol + ↓REM latency on daily basis for ≥3mo; sleep attacks Ass w/ cataplexy, hypnagogic or hypnopompic hallucinations, sleep paralysis ttt: scheduled daily naps + stimulant (amphet); SSRI (for cataplexy)
67
Sleep apnea (2 types)
2* to disturb breathing → excess daytime somnol + sleep disrupt* (arousal stops apnea) - Central: airflow + resp effort cease; morning headaches, mood chang, repeat awaken at night - Obstructive: airflow cease; snoring+++; RF (male, obes, airway surg, anatomic abNl)
68
Sleep apnea (dg, ttt)
Dg: polysomnography, OSA/CSA, mvt dso, seiz, other sleep dso ttt: OSA (CPAP, ↓weight, surg in child if tonsil/adenoid hypertrophy) CSA (BiPAP)
69
Circadian rhythm sleep disorder
Misalignment betw/ desired and actual sleep Types: jet-lag, shift-work, delayed sleep, unspecified ttt: jet-lag (self-resolut* 2-7d); shift-work (light therapy); oral melatonin if 5.5h before desired bedtime
70
Somatic symptom disorder
Excess thoughts/anxiety/behav by presence of somatic sympt; distress daily life +/- medical ds High health care utilizat* ttt: regular appointments w/ 1 Dr; psychotherapy
71
Conversion disorder
``` Def of voluntary motor/sensory fct* incompatible w/ medical ds; close time relation to sev stress/emot* Hoover sign (r/o leg paralysis); eye resist to opening in seiz; ⊖EEG; tremor disappear w/ distract* ``` ttt: psychotherapy
72
Factitious disorders and malingering
Factit: fabrication of sympt or self-injury, assume sick role (1* gain) Factit imposed on another: caregiver makes other ill Maling: intentionally cause sympt (2* gain), financial/housing ttt: psychotherapy, minimal dg/ttt to avoid reinforc behav
73
Sexual and physical abuse (PE)
Esp women <35yo w/ marital discord, subst abuse (ptt or partner), pgnt, ↓socio-eco Victims of childhood abuse: ↑R become adult victims Multiple somatic complaints, fqt ER visits, unexplained injuries w/ delayed ttt, avoid eye contact, genital/anal trauma, STDs, UTIs, psychiatric prob !!partner answers or refuses to leave room
74
Sexual and physical abuse (ttt)
``` Screen of ptt's safety Medical care Emotional support Counseling Educate abt support services + refer !!! documentation ```
75
Suicidality (RF)
30K deaths/y in US; #8 cause of death in US RF: male, >45yo, psychiatric dso, previous attempt, Hx of psy admiss*, subst abuse, recent sev stress, fam Hx, chronic ds, no spouse/support, organized plan, weapons
76
Suicidality (dg, ttt)
Dg: comprehensive eval, ask directly abt suicidal ideat*/plan/weapons ttt: emergent hospit even against ptt's will !!! R may ↑ after antidepr bcz ↑ energy

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