psychoses Flashcards
(196 cards)
1
Q
Delusional Disorders
A
> 1 delusion, >1 month WITHOUT other psychotic sx. must be plausible but unlikely. Lanie.
2
Q
> 1 psychotic sx w/ onset and remission <1month
A
Brief psychotic disorder
Montana w/ frostbite
3
Q
meet schizophrenia definition BUT <1 month
A
schizoPHRENIFORM disorder
4
Q
Schizophrenia + mood disturbance (mania, MDD)
A
ShizoEFFECTIVE disorder
5
Q
Criteria for shizophrenia
A
> 6 months duration of illness with 1 month of acute sx almong w/ funcitional decline
> 2 positive sx and must have 1+ hallucination, delusion, or discoganized speech
6
Q
(+) H sx auditory
A
often 3rd person, can be command
7
Q
(+) H sx olfactory
A
stench foul smell common
8
Q
(+) H sx tactile
A
insects on skin or being touched
9
Q
(+) H sx somatic
A
sensation arising from within the body
10
Q
(+) H sx gustatory
A
can be a part of persecutory delusions (tasting poison)
11
Q
(+) D sx persecutory
A
force/person interfeing with them observing them or wishes harm to the pt
12
Q
(+) D sx Refeence
A
ransdome events take control of patient’s thought, feelings and behaviors
13
Q
(+) sx D reference
A
random events take on a persone sig )directed at them)
14
Q
(+) sx D control
A
some agency takes contol o fpts thoughts eelings and behavors
15
Q
(+) sx D Grandiose
A
Unrealistic beliefs in ones own powers
16
Q
(+) sx D nihilsm
A
exaggered belief in the futility of evyerthing and catastrophic events
17
Q
(+) sx D erotomanic
A
believes another person is in love with them
18
Q
(+) sx D jealousy
A
suspects unfaithful
19
Q
(+) sx D doubles
A
believes someone close to them has been switched by a double
20
Q
(-) sx thought to be caused by dopamine dysfuntion in the mesocoritcal pathway. seritonin may play a role.
A
flat, social withdrawal, lack emotion, avolition (lack self motivation) lack communication, poor eye contact
21
Q
RF schizophrenia
A
MC family hxk
22
Q
MOA 2nd gen antipsycotics
A
dopamine and seritonin antagonists
23
Q
Best for (+) sx
A
1st gen Haloperidol and chlorpromazine BUT cause extrapyrimidal effects
24
Q
2nd gen best when develop resistance to other 2nd gen
A
clozapine
25
AE clozapine
agranuloctyosis get CBCweekly
26
AE olanzapine
DM
27
General AE 2nd gent AP
myocarditits, seizures QT porlongation, weight gain
28
AP 1st gen MOA
only dopamine antagonist. good for (+) sx
29
Extrapyramidal sx (EPS)
rididity, bradykiesia, tremor, akathisia (restlessness)
30
3 EPS syndromes
1. Dyskinesia
2. tardive dyskinesia
3. parkinsominsm
31
Dyskinesia (dystonic reactions) - short term use
Reversible extrapyramidal sx.
happens hours after admin
decreased dop leads to increased ach
trismus, tongue protrussions, facial grimicing, torticollis, difficulty speaking
tx: diphenhydramine IV for anticholinergic properties.
or benztropine for antichokinergic agent
bezos may be used bc mediates dop/ach balance with GABA
32
Tardive dyskinesia (long term us)
long term use
repetative involuntary movement in extremities
lip smacking, teeth grinding, tongue rolling.
33
parkinsonism (low dopamine in nigrostrial)
rigidity tremor
34
In addition to EPS sx of 1st gen there are more SE
NMS, QT prolongation, cardiac arrythmias, sedation, ach effects, dermatitis, blood dyscrasias HIGH PROLACTIC (worse with 2nd gen). WEIGHT GAIN
35
NMS 1st gen
due to dopamine blockade
AMS, rigidity, tremor, autonomic instability, tachycardia, tachypnea, hyperthermia/fever
mgmt. stop agent.
tx hyperthermia w/ cookjng blaken, ice
give DOPAMINE agonists like bromocriptine, amantadine, levo/carb
36
Name 1st gens
haloperidol, droperidol, fluphenazine, perphernaine, chlorpromazine , thioridazine
37
MOA 1st and 2nd
```
1st = dopamine antagonist
2nd = dop and seritonin antagonist
```
38
SE of 2nd gen
EPS (less than 1st esp clozapine and quetiapine)
| Increased prolactin, hyperglycemina, hyperlipidemia, weight gain, NMS
39
Name 2nd gen
quet, olanza, cloza, loxapine
40
Name benzisoxazoles
risperidone, ziprasidon
41
MOA benzisoxazole
Dopaminte antagonist and serotonin antagonist but at diffenet sites than second
42
IND for risperidone, ziprasidone
shciazoprhenia, bipolar, psychosis,
| risperdal ok for tourettes
43
SE rispidone and ziprasidione
EPS, INCREASED prolactin, sedation , weight gain, hypotension, prolonged QT
44
Quinolones
| aripiprazole (abilify)
MOA dopamine and serotonin antaonist, indicated for psychotic disorders. may be called 3rd gen
45
Lithium MOA
increases NorEP and serotonin receptor sensitivity
46
Lithium indications
bipolar, acute mania
47
Lithium SE
HYPOTHYROIDISM. ARRYTHMIAS, sodium depletion. increased urination and thirst, DI, Hyperparathyroid/hypercalcemia.
seizures , tremor, HA, weight gain, GI disturb,
48
Lithium pregnantcy
CI
49
Lithium has a narrow TI
monitor plasma levels every 4 - 8w
50
What behavior can carbamazepine or valproate suppress
impulse and aggressive
51
MDD RF
MC female, 20-40s
52
MDD
2weeks +, must be almost every day, >5 sx
53
MDD sx
andendonia, dis sleep, guilt, workthlessness, suicide, psycholoto agitation, weight change, appetite change, concentraiotn
54
MDD cannot be assoc
bereavment, substances, medical conditions
55
Somatic sx of MDD
constipation, HA, skin changes, chest or abdominal, cough, dyspnea
56
Subtypes "course specifiers" of MDD
1. SAD
2. atypical depression
3. Melancholia
4. Catatonic depression
57
MDD: SAD
same time each year
| mgmt: ssri, light tx, bupropion
58
MDD: atypical depression
similar to MDD
BUT
experience mood reactivity (improved mood w/ (+) ecents)
sx: weight gain, appetitie, increase, hypersomina, heavy leaden felling in arms or legs, oversensitiity to interpersonal rejection
mgmt MAO inhibitors
59
MDD: melancholia
anhedoia, lack mood reactivity, depression, severe weight loss/ app loss, guilt, PA, or PR, sleep,
may have worse mood in the morning
60
MDD: catatonic depression
motor inability, stupor and extreme withdrawl
61
mgmt mild/ mod depression
1. psychotherapy
2. medications
3. electroconvulsive therapy
62
Meds MDD
1st: SSRI
2nd snri, buproprion, mirtazapine
3rd: TCAs and MAO inhibitors
63
Min time to give and antiD
3-6 weeks
64
Name SSRIs
```
citalopram (celexa)
escitalopram (lexapro)
paroxetine (paxil)
fluoxetine (prozac)
sertraline (zoloft)
fluvoxamine (zyvox)
```
65
MOA SSRI
inhibits CNS seritonin receptors from taking back the seritonin and hence increaseing seitonin in the cleft
66
Ind SSRI
1st line depression and anxiety
| less SE, lower toxicity
67
Avoid citalopram in which patients?
long QT
68
SSRI - seritonin syndrome
acute AMS, seizures, coma and death, reslessess, sweating , tremor, hyperthemia, nausea, vomiting, abd pain, mydriasis, tachycardia
69
SNRI names
venlafaxine (effexor)
desvenlafaxine (pristiq)
duloxetine (cymbalta)
70
SNRI MOA
inhibits uptake of seritonin, NE, and DA
71
Ind SNRI
can be 1st line if have MDD with FATIGUE AND PAIN syndromes
| 2nd line if dont respond to SSRI
72
SE SNRI
same as SSRI: hyponatremia, noradrenergic sx
AND: HTN, dizziness
73
CI/ Cautions SNRI
renal/ hepatic ds, seizures
AVOID ABRUPT d/c
caution if have HTN
High suspicion for serotonin syndrome if using St johns wort
74
Name TCAs
```
amitriptyline (elavil)
clomipramine (Anafranil)
desipramine (Normpramin)
doxepin (Sinequan)
imipramine (Tofranil)
Nortriptyline (Pamelor)
```
75
TCAs MOA
inhibits reuptake of serotonin or NE
76
TCAs IND
depression, INSOMINA, DM neuropathy, post herpetic neuroalgia, migraine, urge incontinence.
Nondepressed pts experience sleepiness. depressed patients feel elevated mood
77
TCAs why should not prescribe a truckload to MDD
easy to OD
| Na channel blocker effts: sinuse or wide complex tachycardia, neurologic sx, ARDS, SIADH
78
SE TCAs
ANTICHOLINERGIC, PROLONGED QT (best indicator of OD)
| weight gain, sedation
79
What use for TCA cardiotoxicity?
sodium bicarbonate
80
Tetracyclic compunds
| mirtazapine (Remeron) MOA
inhibits Serotonin and NE
81
mirtazapine (Remeron) Ind
depression. less sexual dysfuction SE. may be used with trazadone
82
mirtazapin S/E and CI
sedation, dry mough constipation, weight gain, AGRANULOCYTOSIS
CI: done use with MAO
83
Buproprion MOA
inhibits neuronal uptake of DA and NE
84
Buproprion indications
wellbutrin depression
| zyban: smoking
85
buproprion SE
SEIXURES, agitation, anxiety, restlesness, weight loss, HTN, HA
LESS GI and Sexual problems
86
Bupropion CI
Seizure disorder
Eating disorder (bc makes not hungry)
drug/ETOH detox
avoid abrupt withdrawl
87
MAO names
phenelzine (nardil)
tranylcypromaine (parnate)
isocarboxazid (marplan)
selegiline (eldepryl)
88
MAO high yield
HTN crisis w/ tyramine containg foods
MAOI + SSRI may cause serotonin syndrome
MAOI + TCA may cause delirium and HTN t
89
Trazadone
MOA serotonin antagonist and reuptake inhibitor. antidepressant, antianxiety, for insomnia
S/E priapism, cardiac arrhythmias
90
BP I
1+ manic or mixed episode which often cycles with occasional depressive episodes but don't need to be MDD
91
BP II
1+ hypomanic and 1+ MDD
| mania or mixed episodes are absent
92
BP 1 facts
1% population. MC RF family hx.
average age onset 20s-30s, rare past 50s
earlier onset more likely psychotic features and poorer prognosis
93
BP I MANIA
elevated, expansive or irritable for 1+ week
impairment social fx
> 3 following
mood: euphoria, irritable, labile, dysphoric
thinking: racing, flight ideas, disorganized, distractable, expansive or grandiose, impaired judgement
behavior: hyperactivity, pressured speech, less sleep, impulsivity, hypersexual, increased goal directed activity, phychotic sx (paranoia, delusions, hallucinations)
94
BPII HYPOmania
sx similar to mania BUT
does not cause impairment or hopitilization
4+ days, no racing thoughts, no agitation
95
MGMT of BP I
1. mood stabilizer
| 2. therapy: cognitive, behavioral, and interpersonal. good sleep hygiene
96
Mood stabilizers BP
1st line lithium, valproic acid, carbamazepine
2nd line 2nd gen antipsychotics: (except olanzipine)
2nd line also 1st gen antipsychotics haloperidol
- if psychosis or agitation develops add benzo
other txs: SSRI, TCA, MAOI or ECT
97
Careful bc SSRI is BP
can cause mania
98
BP 1 and 2
| mania and MDD req
BP1 mania BP2 hypomania
| BP1 maybe depression BP2 MDD
99
Dysthima
persistent depressive disorder
100
PDD = dysthimia define
>2yrs chronic depressed mood (>1 peds)
typicaly milder than MDD
must have 2+
sleep problems, fatigue, low self esteem, diet problems hopelessness, poor concentration, indecisiveness
101
Characteristics of PDD = dysthmia
MC women late teens, early adulthood
may progress to BP or MDD
no sx hypomania, mania, or psychotic features
PESIMISM, low productivity, social withdrawal, loss interest
"Ive always been this way"
102
MGMT Persistent depressive disorder = dysthimia
ssri 1st line
103
Define cyclothymic disorder
less severe BP 2
milder elevations and depressions of mood
may develop BP
men = women
104
Cyclothymic disorder CM
must be 2+ years (1 year peds)
hypomanic sx that dont meet criteria for hypomania
no mania
mild depressive
105
MGMT cyclothymic disorder
mood stabilizers and neuroleptics
106
Define Panic attack
intense fear, abrupt, usually peaks at 10m, lasts <60m
107
are panic attacks a disorder
no, but a feature
108
Panic attack must have 4 +
dizziness, trembling, choking feeling, parasthesias, sweating, SOB, chest discomfort, chills or hot flashes, fear loosing control, fear dying, palpitations, increased HR, abd distress or nausea, depersonalization or derealization.
109
1st line for panic attack
benzo loraz or alpraz
110
Panic disorder demographic
3x more often women. usually before 30years of age
111
criteria of panic disorder
2+ panic attacks
one of the following must last >1 month: 1. concern about future attack. 2. worry about implications of loosing control 3. sig change in behavior related to attacks.
msust have 4 of panic attack sx
must not be related to substance abuse
May have agoriphobia
112
MGMT Panic disorder
long term mgmt
1st line SSRI or snri
2nd line CBT
acute: benzo
113
GAD criteria
```
> 6mos excessive anxiety or worry
not episodic (unlike panic disorders), not situational and not focal
```
must have 3+ fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness and HA. no caused by medical illness
MC females onset in early 20s
114
mgmt of GAD
1. SSRI, snri
2. buspirone
3. benzo, BB, TCA
4. psychotherapy: includes CBT
115
Buspirone info
may take several weeks to work
blocks DA, increases serotonin
SE nausea, restless legs, EPS, dizziness
DOES NOT cause sedation
116
Social anxiety disorder criteria
>6 months, intense fear of social or performance situation in which exposed to scrutiny fear of embarrassment
can cause EXpected panic attack
often know its unreasonable
117
Criteria PTSD
1. direct
2. witness
3. close family/friend
4. first responders to cat. event
118
PTSD must have at least 1 intrusion sx
1. reexperiencing > 1m like flashbacks
2. avoidance of stimuli like events
3. negative alterations in cognition and mood. inability to remember imp parts of event, exaggerated beliefs "world is unsafe", horror guilt anger or shame
4. arousal and reactivity. angry outbursts, irritable, reckless, hypervigilance, sleep and conc prob, exaggerated startle
119
MGMT PTSD
SSRI first line
trazadone can be good for insomnia
CBT
120
Acute Stress disorder
similar to ptsd but less than 1 month
121
Adjustment disorder definition
emotional/BH rxn to indentifiable stressors
with a DISPROPORTIONATE response that would be expected within 3 mos
does not include bereavement
CM 1+
1. marked distress out of proportion
2. sig impairment of function
122
MGMT of adjustment disorders
1. PSYCHOTHERAPY first line
2. meds not preferred but can be added
3. may use substances to cope
123
Define dissociative disorders
loss self, temp alt of consciousness, memory or personality, BH or motor function
124
Dissociative identity disorder (formerly multiple personality disorder)
>2 distinct identities or state of personalities that take control of BH
MC in women
may be assoc with sexual abuse, PTSD, substances
125
Name 3 types of dissociative disorders
1. dissociative identity disorder
2. depersonalization/ derealization disorder
3. dissociative amnesia
126
Depersonization/ derealization disorder
PERSISTENt feelings of detachment or estrangement from
- oneself (detachment)
- surrounding (derealization)
reality testing is intact and sx are distressful
127
Dissociative amnesia
inability to recall autobiographical info
sexual abuse, stress, trauma
dissociative fugue: abrupt change in geographical location. loss of ID to recall past
must r/o seizures or brain tumors
MGMT: psycotherapy
128
List OC disorders
1. OC disorder
2. body dysmorphic disorder
3. hoarding
4. trichotillomania
5. excoriation (skin picking)
129
obsessive compulsive disorder def
anxiety disorder char by combo of thoughts (obsession) and behaviors (compulsions)
men = women, men earlier
20s
130
Define obsessions
recurrent or persistent thoughts/ images. inappropriate and unwanted.
131
Define Compulsions
repetitive BH feels driven to perform to relieve self of obsession.
132
4 major patterns/ CM of OCD
1. contamination: hand washing
2. pathologic doubt: turn oven off
3. symmetry/precision: arrange object with precision
4. intrusive obsessive thoughts without compulsion
133
MGMT OCD
1. SSRI, tca, snri
| 2. CBT
134
Body dysmorphic disorder
1+ body part flawed
repetive acts like mirror checking, seeking reassurance, comparison to others
MC females, may have anxiety or depression
MGMT
antidepressants, psycotherapy
135
Somatic symptom disorder
physical sx in 1+ body part w/o physical cause
MC women before 30yo
usually 6+ months
MGMT: regular appt w/ provider
136
Illness anxiety disorder (hypochondriasis)
6+ months
somatic sx not common but may be mild
MGMT reg scheduled visits w/ provider for reassurance
137
Functional neurological symptom disorder (conversion disorder)
neurologic dysfunction that suggest a physical disorder that cannot be described clinically
NOT intentional or feigned
138
CM functional neurologic symptom disorder (conversion disorder)
tend to be episodic during times of stress. MC females and onset in adolescence or early adulthood
1. motor dysfunction: paralysis, mutism, etc
2. sensory dysfunction: blindness, etc
3. often have depression, anxiety, schiz, or PD
MGMT: psychotherapy
139
Factitious Disorder def
Intentional, fain sick either psych or medical.
inner need seen ill but NOT for gain like malingering
deliberate unlike somatic disorders
140
Types of factitious disorders
1. imposed on self.
| 2. imposed on another
141
CM factitious disorder
1. do things to make themselves look sick
2. willing/eager for surgery or painful tests
may be a healthcare worker
142
malingering
falsification for personal gain
143
Child physical abuse
moms usually
cigarette burns, burns in stocking glove pattern, lacerations, healed fractures, subdural hematoma, bruises, retinal hemorrhages
look for hyphema or retinal hemorrhages in shaken baby syndrome
144
Obesity leads to
DM, CAD, breast and colon cancers
BMI 30
>20% greater than ideal weight
binge eating
145
Describe obesity binge eating
50% recurrent eating a lot. at least weekly fro 3 months
146
MGMT obesity
1. behavioral modification
2. antidepresants if indicated
3. Orlistat (dec GI fat absorption), Lorcaserin (serotonin agonist)
4. surgery
147
Anorexia types
1. restrictive
| 2. purging type vomiting laxatives
148
Dx anorexia
BMI < 17.5 or weight <85% ideal
PE: hypotension, bradycardia, lanugo, dry skin, salivary gland hypertrophy, amenorrhea, arrhythimas, osteoporosis
Labs: leukocytosis, leukopenia, anemia, hypokalemia, increased BUN (dehydration), hypothyroidism
149
MGMT anorexia
1. medical stalization: hosp if <75% ideal or electrolyte disturbance
2. psychotherapy: CBT, supervised meals , weight monitoring
3. pharmacotherapy: depression ssri
150
CM bulimia
1. binge eating: at least weekly for 3 months
| 2. compensatory behavior: purging type (laxative, vomit) OR non purging type restrictive
151
PE bulimia
teeth pitting, enamel erosion, russells sig parotid gland hypertrophy, metabolic alkalosis
152
Labs bulimia
hypokalemia, hypomangesemia
153
MGMT bulimia
1. psychotherapy CBT
| 2. pharmacotherapy: fluoxetine has been shown to reduce binge purge cycle (careful of cardio SE)
154
Name Cluster A personality disorders
1. schizoid - social detachment, weird odd
2. schizotypal
3. paranoid
155
Schizoid PD
cluster A
MC males, loners hermit like, anhedoic, inability to form relationships life long, appears eccentric, cold flattened affect
MGMT: psychotherapy 1st line
156
Schizotypal PD
cluster A
odd eccentric thought patterns but WO psychosis (delusions)
CM: odd in BH and appearance, inappropriate affect, magical thinking (clairvoyance, telepathy). may talk self in public. discomfort in relationships, restricted affect
MGMT: psychotherapy 1st line
157
Paranoid PD
cluster A
pervasive pattern of distrust. MC males.
misinterprets actions of others. hidden messages, easily insulted, grudges, lack interest in social situations, precoupation with doubt of others loyalty
MGMT: psycotherapy 1st line
158
Name cluster B disorders
Dramatic, wild, erractic and impulsive
1. Antisocial PD
2. Borderline PD
3. Histrionic PD
4. Narcissistic PD
159
Antisocial
```
Cluster B
may begin in childhood (conduct)
harmful/hostile
men 3x more women
drunk driving, lack empathy, little anxiety, extremely manipulative, deceitful, abuse, lies
MGMT: psycotherapy
```
160
Borderline PD
Cluster B MC women
unstable, unpredictable
1. extreme, instability, sensitivity to criticism (fear abandoment)
2. black and white thinking
3. impusivity suicide threats, substance abuse, binge eating, spending, reckless driving
MGMT: psychotherapy
161
Histrionic PD
Cluster B
overly emotional, dramatic, seductive, attention seeking, tember tantrums, seeks reassurance and prise often, believes relationships more intimate than truly are, easily influenced
MGMT: psychotherapy
162
Narcissistic PD
Cluster B
MC males
inflated self image, fragile self esteem, reacts criticism with rage, becomes depressed, lack empathy
MGMT: psychotherapy
163
Cluster C names
anxious, worried, fearful
1. Avoidant
2. Dependent
3. Obsessive-Compulsive
164
Avoidant PD
desires relationships but feels inferior
sensitivity to criticism, fears rejection
timid shy lacks confidence
MGMT psychotherapy and medications PRN
165
Dependent PD
Cluster C
needy, clingy, constantly needs to be reassured, relies on others for decision making, may volunteer for unpleasant tasks
166
Obsessive compulsive PD
Cluster C
PD - police department
order, control, rules, inflexible, moral judgement of others, hesitates to delegate work
167
Autism RF
male: female 4:1
168
CM Autism
primary
1. low social interaction
2. impaired communication
3. restricted repetitive stereotyped behaviors
other signs
failure show preference to parents over other adults, unusual sensitivities to smells, visual and auditory stimuli. unusual attachments to objects. savantism
169
Autism MGMT
referral to neuropsychologic testing
BH mods
meds
170
Oppositional Defiant Disorder
```
defiant BH to adults
must be: >6mos
AND have all three
1. angry/ irritable
2. argumentative
3. vindictiveness
MGMT: therapy
```
171
Conduct disorder
```
violate rights other, dont follow norms
social and academic difficulties
4 main areas
1. serious law violations
2. aggressive/ cruel to animals
3. deceitfulness
4. destruction of property
MC boys, most grow into antisocial BH, poor px
```
172
criteria for ADD/ADHD
before 12 and be present for 6 months
| must be in 2 settings
173
Hyperactive components
1. fidgets in seat
2. in motion constantly
3. talks a lot
4. impatience
5. touches stuff
6. trouble sitting for long
7. difficulty doing quiet tasks
8. restlessness
9. blurts
10. interprets conversation and activity of others
174
MGMT ADHD sympathomimetic
| also for narcolepsy, excessive daytime sleepiness
stimulants, tx of choice
methylphenidate (Ritalin), amphetamin/dextroamphetamine (adderall), dexmethylphenidate (focalin)
MOA: increases DA and NE in couple ways
SE anxiety, HTN, tachycardia, weight loss, growth delays and addiction
175
MGMT ADHD 2nd line
Nonstimulants
Atomoxetine (Strattera)
MOA: selective NE reuptake inhibitor
can adjunct w/ bupropion, venlafaxine, guanfacine, clonidine
176
opioid intoxication PE
miosis, resp depression, biots breathing, bradycardia, hypotension
177
Opioid withdrawal
lacrimation, HTN, pruritus, tachycardia, NV, abdominal crams goose bumps, mydriasis, flu like sx
178
MGMT opiod acute
naloxone (Narcan): onset 2 minutes, lasts 30m
179
MGMT opioid withdrawal
symptomatic control: clonidine (dc sympathetic sx), loperamide diahrrea, NSAIDs, buprenorphine + naloxone
methadone tapering. benzos maybe
180
Long term MGMT opioid withdrawl
methadone or suboxone
181
alcohol uncomplicate WD
6-24h, no seizures, DT, or hallucinations
182
Alcohol WD seizures
6-48h, usually generalized T-C. MC single episode
183
alcohol hallucinations
12-48h, visual, aud, tactile hallucinations
| clear sensorium and normal VS
184
Delerium Tremens
2 - 5 days
Delerium (altered sensorium), hallucinations, agitation
Abnormal VS (tachy, HTN, fever, sweating)
185
MGMT alcohol WD
1. IV benzo
2. IV fluids and supplements
3. avoid meds that lower seizure threshold
186
Benzodiazepines
MOA GABA inhibition
ethanol mimics GABA so WD has increased CNS activity
titrate to slightly somnolent and taper
lorazapam or oxazepam preferred if have cirrhosis
187
Name the benzo
Diazepam (Valium)
Lorazepam (Ativan)
Chlordiazepoxide (Librium)
Oxazepam
188
Describe IV supplementation alcoholics
```
IV thiamine and magnesium
then can give glucose second
multivitamins including B12/folate
IV fluids plus dextrose
if glucose and thiamine out of order could cause Korsakoff's
```
189
Avoid meds lower seizure threshold
bupropion, haloperidol, anticonvulsant, clonidine, BB
190
CAGE screening
```
Cutdown: felt need to cutdown?
Annoyed: people told you about drinking?
Guilt: felt guilty?
Eye opener: needed morning dose?
need 2+
```
191
MGMT alcohol abuse
1. supportive AA
2. disulfaram (antabuse)
3. naltrexone : opiod antaganist reduces euphoria and craving
4. gabapentin, topiramate
192
Disulfaram (Antabuse)
MOA: inhibits aldehyde dehydrogenase so get uncomfortable sx
CI: CVD, DM, hypothyroid, epilepsy kidney or liver ds
193
Suicide RF
```
MC previous attempt or threat (plan?)
completes older, but teenagers try most
elderly white men is the highest
white> black
most have underlying psych disorder
SA increased risk
marital status:
alone> never married > widowed > sep/divorced > married w/o > married with
```
194
Grief rxn
only bereavement disorder considered mental disorder
195
How long is normal grief
1 yr may turn to MDD
196
Grief rxn: abnormal grief
suicide ideation, psychosis, psychomotor deficits, illusions, hallucinations
