Psychiatry VII Flashcards
(42 cards)
What is the next step in management for a patient that requires antipsychotics, but develops tardive dyskinesia while taking risperidone?
Switch to clozapine
newly added to UWorld = treatment of tardive dyskinesia with valbenazine (VMAT2 inhibitor)
What is the next step in management for a patient with recurrent episodes of psychosis due to medication non-adherence? The patient responds well to oral antipsychotics.
Long-acting injectable antipsychotics
What is the next step in management for an elderly patient with major depression with psychotic features that has lost a significant amount of weight and is refusing to eat/drink?
Electroconvulsive therapy (ECT)
ECT is appropriate for severely depressed geriatric patients who require rapid intervention; antidepressants + antipsychotics would take too long to be effective
What is the next step in management for that begins SSRI therapy for anxiety that develops worsening anxiety and insomnia?
Decrease the SSRI dose
patients with anxiety disorders are more sensitive to the activating side effects of SSRIs and may benefit from starting at a low dose or temporary dosage reduction
What is the pharmacotherapy of choice in pediatric depression patients?
SSRIs, especially fluoxetine
What is the preferred pharmacotherapy for alcohol withdrawal in the hospital setting?
IV lorazepam (benzodiazepine)
intermediate-acting with no liver metabolites, therefore it is preferred in patients with possible liver disease
What is the recommended first-line treatment for moderate-severe premenstrual syndrome and premenstrual dysphoric disorder?
SSRIs
What is the recommended immediate treatment for patients with panic disorder that are acutely symptomatic?
Benzodiazepines
benzodiazepines can also be used temporarily to treat panic disorder while waiting for SSRIs/SNRIs to take effect
What is the recommended long-term treatment for patients with panic disorder?
CBT and/or SSRIs
What is the recommended maintenance pharmacotherapy for a patient with bipolar disorder that is not adequately controlled with monotherapy?
lithium or valproate + a second-generation antipsychotic (e.g. quetiapine)
monotherapy typically begins with a mood stabilizer (e.g. valproate, lithium, lamotrigine)
What is the recommended maintenance treatment for a patient with a history of kidney disease that presents with bipolar I disorder?
Valproate
lithium and valproate are first-line treatments, however lithium has potential nephrotoxic effects; other effective treatment options include quetiapine and lamotrigine
What is the recommended next step in management in assessing a patient with suspected premenstrual syndrome (PMS)?
Menstrual diary
What is the recommended pharmacotherapy for a patient with a history of alcohol abuse that requests a medication to reduce cravings? He is currently drinking 6-7 beers a day. There is no evidence of hepatitis or cirrhosis.
Naltrexone
contraindicated in patients taking opioids and those with acute hepatitis or liver failure; acamprosate may be used to decrease cravings but is initiated after abstinence is achieved
What is the recommended pharmacotherapy for Tourette disorder refractory to alpha-agonists (e.g. clonidine, guanfacine)?
Antipsychotics
the only FDA approved drugs are the first-generation antipsychotics haloperidol and pimozide; second-generation antipsychotics (e.g. risperidone) are increasingly preferred due to favorable side effect profile
What is the recommended treatment for a child with intermittent sleep terrors?
Reassurance
most cases resolve spontaneously in 1-2 years; frequent, persistent, and/or distressing sleep terrors may be treated with low-dose benzodiazepines
What is the recommended treatment for bereaved patients who meet criteria for major depressive disorder?
psychotherapy + antidepressants
bereaved patients that meet criteria for MDD should be treated for MDD
What is the recommended treatment for dissociative identity disorder?
Trauma-focused psychotherapy
DID is associated with severe childhood trauma
What is the recommended treatment for oppositional defiant disorder?
psychotherapy and parent management training
What is the recommended treatment for post-stroke depression?
CBT and/or SSRIs
post-stroke depression is underdiagnosed and associated with increased disability and mortality
What is the recommended treatment for seasonal affective disorder?
Bright light therapy +/- an antidepressant
most often characterized by depression with fall-winter onset and spring-summer remission
What is the treatment for both conduct disorder and antisocial personality disorder?
Psychotherapy (e.g. CBT)
What is the treatment for cocaine intoxication?
[…], α-blockers
benzodiazepines, α-blockers
note: β-blockers are contraindicated
What is the treatment for cocaine intoxication?
benzodiazepines, […]
benzodiazepines, α-blockers
note: β-blockers are contraindicated
What is the treatment for delirium tremens?
Benzodiazepines
e.g. lorazepam
