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Psychiatry > Treatment > Flashcards

Treatment Flashcards

1
Q

Best treatment for catatonic type major depressive disorder:

A

ECT

Only following benzodiazepines

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2
Q

Best treatment for manic woman during pregnancy:

A

ECT

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3
Q

Most common mood stabilizers:

A

Lithium
Valproate
Carbamazepine

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4
Q

Best treatments for rapid cycling BPD:

A

Valproate

Carbamazepine

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5
Q

Classes of drugs valproate and carbamazepine fall under:

A

Anti-convulsants + mood stabilizers

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6
Q

Possible drugs used for bipolar disorder:

A

Mood Stabilizers
Anticonvulsants / Mood Stabilizers
Atypical Antipsychotics (for acute mania)

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7
Q

Side effects of Lithium:

A 
Weight Gain
Tremor
GI disturbances
Fatigue
Cardiac Arrhyhtmias
Seizures
Goiter / hypthyroidism
Leukocytosis
Coma
Polyuria
Polydipsia
Alopecia
Metallic Taste
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8
Q

Treatment for dysthymic disorder:

A

Cognitive and insight-oriented psychotherapy

Antidepressant medications

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9
Q

Treatment of cyclothymic disorders:

A

Mood Stabilizers

Anti-convulsants

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10
Q

Treatment of adjustment disorder:

A

Supportive psychotherapy
Group Therapy
Anti-depressants, sleep aids, anxiolytics for associated symptoms.

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11
Q

Indications for SSRIs:

A

Depression

Long term treatment of Social Phobia

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12
Q

Best treatment for social phobia:

  • 1st line
  • Short Term Relief
  • Long Term Therapy
A

1st line = cognitive behavioral therapy with desensitization techniques.

Short Term Relief: Benzodiazepines or ß-blockers

Long Term Therapy: SSRI, SNRI, buspirone (anxiolytic)

**Buspirone essentially potentiates the therapeutic strength of the SSRI.

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13
Q

Best ß-blockers to use for anxiety:

A

Propanolol

Atenolol

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14
Q

Venlafaxine drug class:

A

SNRI

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15
Q

Therapeutic indications of amphetamines:

A

Narcolepsy
ADHD
Depressive Disorders

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16
Q

Treatment for amphematine intoxication:

A

Rehydrate
Correct electrolyte imbalance
Treat hyperthermia

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17
Q

treatment for barbituate OD:

A

ABCs
Monitor vitals
Activated charcoal and gastric lavage if within 4-6 hrs
Alkalinize urine with sodium bicarbonate (increases renal excretion)

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18
Q

Treatment of choice for opiate OD:

A

Naloxone

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19
Q

Issue developing if meperidine and MAOIs are taken together?

A

Serotonin Syndrome

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20
Q

Treatment of moderate symptoms associated with opiate withdrawal:

A

Clonidine (sympathetic symptoms)
NSAIDs for pain
Dicyclomine (for abdominal cramps)

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21
Q

Treatment for opioid withdrawal with severe symptoms:

A

Detox with buprenorphine or methadone

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22
Q

treatment for hallucingens:

A

Monitor for dangerous behavior

Benzos and antipsychotics

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23
Q

Treatment for inhalant intoxication:

A

ABCs

Check the toxicology since some will require chelation (unleaded gasoline).

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24
Q

Treatment of nicotine dependence:

A

Varenicline - alpha4-ß2 nicotinic cholinergic receptor (nAchR) partial agonist which mimics the action of nicotine and prevents withdrawal

Bupropion - Antidepressant with will increase DA and is also a partial nAchR agonist.

Nicotine Replacement Therapy (NRT)

Behavioral counseling

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25
Q

Treatment of ADHD

A

Methylphenidate

Atomoxetine

Alpha 2 Agonists (clonidine, guanfacine)

Psychotherapy focused on behavior.

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26
Q

Treatment for Childhood disintegrative disorder

A

Supportive

Specifically focus on helping the child relearn the lost basic skills.

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27
Q

Treatment for Tourette’s

A

Moderate Cases:

  • Atypical Antipsychotics (risperidone)
  • alpha-2 agonists (clonidine)

Severe Cases:
- Typical Antipsychotics (haldol)

Stimulants (ritalin) are controversial for patients with Tourette’s AND ADHD, since the stimulants can exacerbate the tics.

SSRI therapy if the patient has comorbid OCD

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28
Q

Treatment of enuresis

A

Take into account high spontaneous remission rate

Psychotherapy, CBT, family therapy.

Alarms

DDAVP

TCAs

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29
Q

Treatment for separation anxiety

A

Family therapy + CBT

Low dose anti-depressants

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30
Q

which are the weight neutral 2nd generation antipsychotics:

A

Aripiprazole

Ziprasidone

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31
Q

Side effects of typical antipsychotics:

A

EPS (dystonia, dyskinesia)

Anticholinergic Toxidrome

Tardive Dyskinesia

Neuroleptic Malignant Syndrome

Prolonged QT Syndrome

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32
Q

Main side effect of concern with clozapine?

Steps you take to monitor this?

A

Agranulocytosis

Therefore perform weekly blood draws if this medication is to be used.

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33
Q

Treatment of schizophreniform disorder:

A

Hospitalization

3-6m course of antipsychotics

Supportive therapy if necessary

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34
Q

Treatment of schizoaffective disorder:

A

Hospitalization

Supportive psychotherapy

Antipsychotics

Mood Stabilizers

Antidepressants

ECT

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35
Q

Treatment of Delusional Disorder:

A

In general it is extremely difficult to treat:

  • Hospitalization
  • Psychotherapy
  • Typical Antipsychotics (typically ineffective)
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36
Q

Treatment of Shared Psychotic Disorder:

A

Removal of the patient (typically a family member) from the inducing patient–this is the most important intervention.

Psychotherapy

Short course of antipsychotics if symptoms haven’t improved 1-2 weeks after separation of the patients.

37
Q

Best treatment for delirium:

A

Haloperidol

38
Q

Benzos and delirium:

A

Typically you should not use these, because this can exacerbate the delirium.

However, if the cause of the delirium is alcohol or benzodiazepine withdrawal, you should give the patients benzos.

39
Q

How to treat Alzheimer’s Dementia:

A

There is no cure or truly effective treatment.

Physical and emotional support as well as exercise and dieting.

Cholinesterase inhibitors, can be used to delay mild to moderate disease for 6-12 months.

NMDA Antagonists - used for moderate to severe disease.

40
Q

Specific cholinesterase inhibitors used for Alzheimer’s Dementia:

A

Tacrine

Donepezil

Rivastigmine

Galantamine

41
Q

Specific NMDA Antagonists used in Alzheimer’s:

A

Memantine

42
Q

Treatment for vascular dementia:

A

No cure or truly effective treatment.

Physical and emotional support, proper nutrition, exercise

Antihypertensives

Cholinesterase inhibitors

43
Q

Treatment for Lewy Body Dementia:

A

Cholinesterase Inhibitors (help with visual hallucinations)

Psychostimulants, levodopa/carbidopa, dopamine agonists (for cognition, apathy)

Atypical Antipsychotics (for delusions)

Clonazepam (REM sleep behavior disorder)

44
Q

Treatment for Frontotemporal dementia (Pick Disease):

A

Anticholinergics

Antidepressants

(These therapies will improve the behavioral issues, but not the cognitive decline).

45
Q

Treatment for HIV associated dementia:

What does each component specifically improve?

A

HAART (improves cognition)

Psychostimulants (Improves fatigue and psychomotor retardation)

46
Q

Treatment for Huntington’s Dementia:

A

None

47
Q

Treatment for Male Erectile Disorder:

A

Phosphodiesterase 5 inhibitors (sildenafil)

Alprostadil (injection)

Vacuum pumps, constrictive rings, surgical insertion of semirigid or inflatable tubes into the corpus cavernosa.

48
Q

Treatment of premature ejaculation:

A

SSRI

TCA

Squeeze technique or stop-start technique

49
Q

Treatment of hypoactive sexual desire disorder:

A

Testosterone replacement therapy in men.

Low dose testosterone in women.

50
Q

Treatment of male orgasmic disorder:

A

Gradual progression from extravaginal to intravaginal ejaculation through masturbation.

51
Q

Treatment for female orgasmic disorder:

A

Masturbation with a vibrator

52
Q

Treatment of dyspareunia:

A

Gradual desensitization to achieve intercourse, including relaxation techniques, progressing to erotic massage, and finally onto sexual intercourse.

53
Q

Treatment of vaginismus:

A

Periodic dilation of the vagina with fingers or a dilator

54
Q

Best treatment options for paraphilias:

A

Insight oriented psychotherapy

Behavior therapy = aversive conditioning

Pharmacologic therapy = antiandrogens

55
Q

Treatment for Gender Identity Disorder:

A

Psychotherapy (involving the family if the patient is young)

Sex reassignment by hormonal or surgical methods in adults

56
Q

(1) Pharmacologic Treatment for “Pseudodementia”
(2) Specific TCA to use and why?
(3) What is mirtazepine, and what are the pros and cons of using it?
(4) Non-pharmacologic therapies?

A

(1) Low dose SSRI > SNRI > TCA > MAOi; and potential addition of Methylphenidate
(2) Nortriptyline is the TCA of choice since it will have the fewest anticholinergic side effects.
(3) Mirtazepine is an SNRI which will increase appetite and sedate patients. Therefore, it should not be used early on in the day, and rather later at night. It is a great drug to use in pseudodementia patients with comorbid sleep disturbances and poor appetite.
(4) ECT; Supportive psychotherapy; community resources; ECT.

57
Q

(1) Treatment of Sleep Disorders in the elderly

(2) Role of benzos:

A

(1) Non-pharmacologic therapy should be attempted first including, elimination of EtOH, elimination of daytime naps, improving daily schedule structure, and treatment of comorbid medical conditions.

Pharmacologic therapy includes:
- Sedative-Hypnotic Drugs –> Hydroxyzine or trazodone

(2) Benzos should not be used, since the therapeutic index is low compared to hydroxyzine or trazodone.

58
Q

Reason for increased rate of side effects of medications in elderly patients:

A

Decreased lean body mass

Decreased liver function

Decreased kidney function

59
Q

Treatment for dissociative amnesia:

A

Psychotherapy is the mainstay of treatment

Psychopharmacology for comorbid symptoms, such as depressed mood, to help the patient talk more freely during psychotherapy.

Hypnosis, sodium amobarbital, or lorazepam to reduce inhibition during therapy sessions.

60
Q

Treatment for Normal Pressure Hydrocephalus:

A

Placement of ventriculoperitoneal shunt

61
Q

Treatment for Somatization Disorder:

A

Supportive and psychotherapy.

62
Q

Treatment for Conversion Disorder:

A

Insight Oriented Psychotherapy

Hypnosis

Relaxation therapy

63
Q

Tx of Hypochondriasis:

A

Regularly scheduled visits to a single PCP.

CBT

Tx of comorbid depression or anxiety with appropriate medications (SSRI).

64
Q

Treatment of body dysmorphic disorder:

A

SSRI help about 50% of patients

Psychotherapy

Surgery or dermatologic procedures almost never help.

65
Q

Treatment for Pain Disorder:

Efficacy of analgesics:

A

Psychotherapy, biofeedback, hypnosis.

SSRI

Analgesics do not work for this disorder, and frequently just result in dependence for these patients.

66
Q

Treatment of Intermittent explosive disorder:

A

SSRI (esp. fluoxetine)

Mood Stabilizers

Anticonvulsants

Propanolol

Group and family therapy

67
Q

Treatment of Kleptomania:

What are the different types of behavior therapy you can employ?

A

Insight Oriented Psychotherapy

Behavior Therapy

SSRI

Types of behavior therapy include: (1) Systematic Desensitization; (2) Aversive conditioning.

68
Q

Treatment of Pathological Gambling:

A

Gambler’s Anonymous (12-step) – this is the best tx

Insight oriented psychotherapy (after 3m of abstinence)

Treatment of comorbid mood disorders, like MDD, anxiety, or substance abuse.

69
Q

Treatment of trichotillomania:

A

SSRI

Antipsychotics

Lithium

Potentially behavior therapy such as hypnosis, or relaxation techniques.

70
Q

Treatment of pyromania:

A

Behavior therapy

Supervision

SSRI

71
Q

(1) Treatment of anorexia nervosa:
(2) Reason SSRI’s don’t really work
(3) When patients must be treated inpatient:

A

(1) Food is #1
- Low dose atypical antipsychotics
- Benzodiazepines before meals (reduces postprandial anxiety)
(2) SSRIs won’t work because the patient’s don’t have enough tryptophan to make serotonin anyways.
(3) Must be treated inpatient if 20% or below ideal body weight, or if there is some other severe psychiatric or medical illness which is complicating things.

72
Q

(1) Treatment for Bulimia Nervosa:
(2) Specific drug most commonly used:
(3) Drug to avoid and why?

A

(1) SSRIs (1st line)
- CBT
- Group/family therapy
(2) Fluoxetine
(3) Bupropion, due to it’s side effect to lower seizure threshold.

73
Q

Treatment for Binge-Eating Disorder:

A

Psychotherapy and CBT

Strict diet and exercise program.

Stimulants like phentermine and amphetamine to reduce appetite.

Orlistat to inhibit pancreatic lipase

Sibutramine (5HT, NE, and DA reuptake inhibitor)

Treat comorbid psychiatric illnesses.

74
Q

Main electrolyte issue with SSRI:

A

Hyponatremia due to SIADH which is commonly caused by SSRI

75
Q

Treatment for delirium in elderly medically ill patients:

A

Haldol

76
Q

Methadone and pregnancy:

A

Methadone is FDA approved for OK use during pregnancy

77
Q

Treatment for dissociative fugue:

A

Psychotherapy is the mainstay of treatment

Psychopharmacology for comorbid symptoms, such as depressed mood, to help the patient talk more freely during psychotherapy.

Hypnosis, sodium amobarbital, or lorazepam to reduce inhibition during therapy sessions.

78
Q

Treatment of dissociative personality disorder:

A

Hypnosis guided interviews

Drug-assisted interviews

Insight oriented psychotherapy

79
Q

Treatment of depersonalization disorder:

A

Anxiolytics

SSRI

80
Q

Treatment for Dyssomnias:

A

CBT

Improve sleep hygiene

Benzos

Zolpidem (Ambien); eszopiclone (Lunesta); Zaleplon (Sonata)

Sedating antidepressants (trazodone)

81
Q

Treatment of Narcolepsy:

A

Improved Sleep Hygiene

Scheduled Naps

Avoid Shift Work

For Excessive Daytime Sleepiness: Amphetamines, methylphenidate, modafenil, sodium oxybate

For Cataplexy: Sodium oxybate (Xyrem); TCA, SSRI, SNRI

82
Q

Treatment of Sleep Walking:

A

Removal of precipitating factors

Improving sleep hygiene

Clonazepam

TCA

83
Q

Treatment of Sleep Terrors:

A

Reassurance that the condition is benign and self-limited

Consider low dose, short acting benzos in refractory cases

Sleep hygiene, psychotherapy

84
Q

Treatment of Nightmare Disorder:

A

Imagery Rehearsal Therapy

Antidepressants for severe cases

85
Q

Treatment of REM Sleep Behavior Disorder:

A

Clonazepam

Imipramine, carbamazepine, pramipexole, levodopa

Maintain safe environment

86
Q

Most common side effects of DDAVP:

A

Nausea

Headache

87
Q

Most common side effects of Fluoxetine:

A

Fluoxetine is an SSRI, therefore:

  • GI symptoms
  • Insomnia
  • Agitation
  • Sexual Dysfunction
  • Headaches
88
Q

Treatment of Catatonia:

A

Benzos

ECT

  • First try a trial of benzos, and then move onto ECT if necessary.
89
Q

Contraindications to ECT:

A

No absolute contraindications

The closest thing to an absolute contraindication is any space occupying brain lesion, since there is an increase in ICP associated with ECT which can cause issues.

Psychiatry (14 decks)

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