UW Flashcards
(95 cards)
1
Q
SSRI in breastfeeding
A
sertraline
2
Q
clozapine for schizo only if fails with … (number) medications
A
2
3
Q
somatic symptom disorder - management
A
regularly scheduled appointments, which establish a strong physician-patient relationship and limit diagnostic testing and subspecialty referrals
(rarely respond to reassurance)
4
Q
somatic symptom disoreder - clinical features
A
1 or more somatic symptoms causing distress + functional impairent
- excessive thoughts or behaviors related to somatic symptoms
- more than 6 months
5
Q
severe symptoms of benzo withdrawal
A
psychosis + seizures
6
Q
folie a deux - most important frist intervention
A
separate the pair to disrupt the mutually reinforcing nature of the shared delucion and to enable a more careful assessment to each individual pathology
- psychiatric treatment in the dominant, the nondominant individual rarely need drugs
7
Q
intermittent explosive disorder?
A
like antisocial but without history of conduct disorder or other fearures of antisocial
8
Q
borderline - history of …… is common
A
childhood trauma
9
Q
type of amnesia as a SE of electroconvulsive therapy
A
anterograde and retrodrage
retrograde persists longer
10
Q
Electroconvulsive therapy - contraindications
A
no absolute
- increased risk if:
- severe CVD, recent MI
- space occupying brain lesion
- recent stroke, unstable aneurysm
11
Q
suicidal patient - when t admit
A
if ideation, intnet + plan
- if ideation but no plan or intent –> ensure close follow up, treat mdifiable RF (depression etc), recruit family or friends to support, reduce acces to potentioal means
12
Q
best combination for bipolar (if not controled by single drug)
A
lithium or valproate PLUS 2nd generation antipsychotic
13
Q
evidence based monotherapy options for bipolar
A
lithium, valproate, quetiapine, lamotrigine
14
Q
specific phobia - history and clinical features / treatment
A
- marked anxiety about a specific object or situation (the phobic stimulus) for more than 6 months
- common types: fear for flying, heights, animas etc)
- common 10%
- usually develops in childhood, often after traumatic events
treatment: CBT with exposure, benzo in acute
15
Q
agranulocytosis - definition
A
complete absence of NEUTROPHILS
16
Q
1st line treatment for anorexia nervosa
A
nutritional rehab
+
psychoterapy
17
Q
anorexia nervosa - indications for hospitalization
A
- bradycardia (less than 40) 2. dysarhythmia 3. hypotension (less than 80/60) 4. orthostasis
- hypothermia (less than 35) 6. electrolyte disturbances 7. marked dehydration 8. organ compromise 9. BI less than 15
18
Q
treatment of PCP
A
1st line: benzo
2nd line: haloperidol
3rd line: propofol
19
Q
dextromethorphan in children can cause
A
hallucinations
20
Q
how to seperate use of cocaine from maniac
A
cocaine has physical symptoms: dilated pupils, diaphoresis, tremors
21
Q
Narcolepsy - diagnostic criteria
A
recurrent lapses into sleep or naps (at least 3 times per week for 3 months) PLUS 1 of the following: - cataplexy - low hypocretin-1 in CSF - shortened REM sellp latency
22
Q
increased sensitivity to lactate infusion has been associated with
A
panic attacks
23
Q
abnormalities in cortico-striato-thalamo-cortical circuits have been associated with
A
OCD
24
Q
how to decrease the trisk or replapse in schizophrenia
A
miniimzaing conflicts and stress in home
- family psychosscial interventions are indicated
25
commonly abused inhalants
glue, toluene, nitrous oxide, amyl nitrite, spray paints
26
inhalant abuse - effects
immediate effect lats 15-25 mins
acts i CNS
- can cause dermatitis (glue sniffer;s rash) around mouth or nostrils)
liver function test may be elevated
- chronic nitrous oxide casues Vit B12 def
27
gender dysphoria - initial management
- assessment of safety
- support, psychoterapy (individual, family)
- referral to specialist services (medical + mental health multidisciplinary)
28
sleep terrors - management
reassurance
| low dose of benzo at bedtime if episodes are frequent, persistent and distressing
29
cognitive impairment in elderly patients - ddx
1. normal aging
2. Major depression
3. Mild neurocognitive disorder
4. major neurocognitive disorder (dementia)
30
cognitive impairment in elderly patients - normal aging
slight decrease in fluid intelligence (ability to process new information quickly, normal functioning in daily activities
- word finding difficulty
31
unexplained abd pain and new onset neuropsychiatric symptoms (including neuropathies, anxiety, mood changes, psychosis)
acute intermittent porphyria
32
disulfiram vs naltrexone vs acamprosate as treatment of alcoholism
naltrexone --> to reduce craving (in active drinkers)
disulfiram --> in abstinent patients (2nd line)
acamprosate --> abstinent patients
33
naltrexone - contraidincations
liver problems
| patients on opioids
34
acamprosate contraindications
renal failure
35
DDX of depressed mood
1. Major depressive
2. Dysthymia
3. Adjustment disorder with depressed mood (within 3 months of stressor event, marked distress or/and functional impairment)
4. Normal stress response
36
normal stress response
- not excessive or out of proportion to severit of stressor
| - no significant functional impairment
37
how to stop a seretonergic antidepressant
gradually (with a taper)
| if abrupt or rapid taper of a short HL --> psychological and physical symptoms
38
antidepressant discontinuation syndrome - manifestations / management
dysphoria, fatique, insomnia myalgias, flu liike, GI , tremor, neurosensory
begin within 2-4 days after the stopping of medication
- management: re-institute the same andtidepressant and taper the dose gradually over 2-4 weeks, or start fluoxetine which is long HT and stop it gradually
39
general anxiety disorder - when to give benzo
nondepressed patientswithout a history of substance abuse who fail to respond to or cannot tolerate antidepressants
40
normal aging vs dementia (major cognitive disorder) - memory loss
- in aging they can provide details about incidents of forgetfulness
- patients are more concern about memory loss
- recent memory for important events + conversations is intact
41
normal aging vs dementia (major cognitive disorder) - word findings difficulty
in aging is occasional WITHOUT receptive aphasia
42
normal aging vs dementia (major cognitive disorder) independence + functioning
- in aging they maintain independence in daily activities
- able to operate common appliances (devices)
- Maintains interpersonal social skills
- not lost in familiar territory (may have to pause briefly to reorient)
43
OCD -time
consuming more than 1 h / day or causing significant distress or impairment
44
Major depressive disorder - season
seasonal pattern characterised by seasonal onset and remission (MC fall-winter onset and spring-summer remission
treatment: bright light therapy alone or with an antidepressan
45
medication-induced psycotic disorder
acute onset of delusions and/or hallucinations that are temporally associated with the use of a new medication
- glucocorticoids (esp high doses) are often implicate
46
conversion disease - management
education about the disorder --> if not respond --> CBT
47
HIV-associated dementia
severe form of dementia in untreated and/or long-standing HIV and CD less than 200
- subcortical symptoms early in the course
48
HIV mediated dementia - number of CD4
less than 200
49
2ry causes of acute onset psychosis in children _ adolescents
1. medical disorders: CNS injury / dysfunction, metabolic / electrolyte disturb / systemic (SLE, thyroiditis)
2. Illicit substance: hallucinogen, marijuana, sympathomimetics (cocaine), alcohol withdrawal, Bath salts
3. Medication SE: intoxitation or withdrawal
50
another SE of lithium
hyperparathyroidism
51
baseline studies for lithium
- urea, Cr, Ca2+, urinalysis
- Thyroid function test
- ECG coronary risk factors
52
How to differentiate Parksinon disease dementia from Lewy bodies
by timing of symptom onset
| if parkinsonism predates cognitive impairment by more than 1 year, then is Parkinson
53
treat depression with Buproprion if
smoking cessation and weight loss are also goals
54
anorexia nervosa - Thyroid
often have low levels of T3 and/o T4 (euthyroid sick syndrome) due to body;s adaption to chronic nutritional depletion --> no thyroid replacement (dangerous for cardiac arrhythmias and osteopenia)
55
generalised anxiety disorder - time
6 months or more
| it can be years
56
neuroimaging of schizophrenia
loss of cortical tissue volume with ventrical enlargement is a subset of patients with schizo, with lateral ventricular enlargement being the most widely replicatied finding
- decreased volume of amygdala and hyppocampus
57
autism - neuroimaging
accelerated head growth during infancy and increaesd total brain volume
58
OCD - neuroimaging
structural abnormalities in the orbitofrontal cortex and basal ganglia
59
Metabolic effects of the 2nd generation antiphsycotics - highest risk drugs / how to monitor
1. Clozapine 2. Olanzapine
Baseline + regular follow-up: BMI, fastign glucose + lipids, BP, waist circumference (at 3 months and then annually)
- more frequent if DM or gained more than 5% of initial weight
60
Antipsychotic extrapyramidal effects - definition
1. acute dystonia: sudden sustained contraction of the next, mouth, tongue and eye muscles
2 .Akathisia: subjective restlessness, inability to stil still
3. Parkinsonism: Gradual onset tremor, rigidity, bradykenesia
4. Tardive dyskinesia: Gradual onset tremor after prolonged therapy (more than 6 months): dyskenesia of the mouth, face, trunk and extremeties
61
antipsychotic extrapyramidal effects - treatment
1. acute dystonia: benzotropine, diphenhydramine
2. akathisia: propranolol, lorazepam, benzotropine
3. parkinsonism: benzotropine, amantadine
4. Tardive dyskinesia: stop the drug is possible, if it is not: switch to 2nd generation (esp clozapine), valbenazine
62
abused drug that causes Seretonin syndrome
ecstasy
| bath salts
63
illicid synthetic amphetamines and analogs - name 2 drugs / urine
1. MDMA (ecstasy) 2. bath salt
| may or may not show up as amphetamnies in routine urine toxicology
64
bath salts can cause
amphetaminese anaoge: seretonin syndrome. agitation, combativeness, acute psychosis, less likely hyponatremia
65
capacity?
patient's ability to understand the illness, treatment options and consequences and to express a choice reflecting a preference
- communicates, understands, appreciates, rationale
66
diagnosis of depression - next step
evaluate for suitability (ideation, intent, plan)
67
treatment of ADHD in patient with history of substance abuse
atomoxetine
68
ADHD - CBT?
medication is generally considered as 1st line --> CBT can be added if medication is not fully effective or as monotherapy if medication is contraindicated
69
clonidine + guanfancine in ADHD
only in children
| not effective in adults
70
dopamine pathways
1. mesolimbinc: antipsychotic efficacy
2. nigostratial: extrapyramidal symptoms
3. tuberoinfundibular: hyperprolactinemia
71
post-stroke depression
common and underdiagnosed
increased disability and mortality
benefit from SSRI
72
2nd generation antipsycotics - mechanism
seretonin S2 and dopamine D2 antagonists
| the added serotonin n receptor binding reduces the likelihood of extrapyramidal side effects
73
neuroleptic malignant syndrome - treatment
1. stop antipsychotcis or restart recent dopamine agents
2. supportive care (hydration, cooling, ICU
3. refractory --> dantrolene or bromocriptine
74
the risk of lithium toxicity is increased with concurrent use of
thiazide, ACEi, tetracyclines, metronidazole, NSAID
or overdose
or volume depletion
75
lithium acute toxicity
GI: nausea, vomiting, diarrhea
| late naurologic sequence
76
alcohol withdrawal syndrome - manifestations / time
1. mild withdrawal: 6-24h
2. seizures: 12-48h
3. alcholic hallucinosis: 12-48h
4. delirium tremens: 48-96h
77
alcohol withdrawal,mild withdrawal - time / symptoms
6-24h
| anxiety, insomnia, tremors, diaphoresis, palpitations, GI, INTACT ORIENTATION
78
alcohol withdrawal, seizures - time and symptoms
12-48
| single or multiple generalized tonic-clonic
79
alcohol hallucinosis - time and symptoms
12-48
| visual, auditory or tactile, INTACT ORIENTATION, STABLE VITALS
80
delirium tremens - time and symptoms
48-96h
| confusion, agiation, fever, tachycardia, hypertension, diaphoresis, hallucinations
81
body dysmorphic disorder - main characteristic
defects are not observable or appear slight to others
82
body dysmorphic disorder - treatment
1. SSRI
| 2. CBT
83
personality traits vs mood disorders
mood dirorders are not for a whole life and have more symptoms
84
RF for prescription opiod misuese include
1. younger than 45
2. psychiatric disorder
3. personal or family history of substance disorder
4. presensce of a legal history
85
how to reduce the risk for prescription opioid misuse
1. review of the state's prescription drug monitoring program data
2. random urine drug screens
3. regular follow up are
86
guidelines for opioids follow up
every 3 months, and even more frequently in high risk situation
87
MC side effects of methylphenidate
anorexia
weight loss
insomnia
88
hoarding disaster?
distinct from OCD
- accumulation of a large number of possessions that may clutter living areas to the point that they are usuable --> distress when attempting to discard possessions
89
hoarding disorder - treatment
CBT
| SSRI may be used in paralle, but with limited effect
90
active suicidal teenager doesn't want to inform parents - next step
inform the parent and hospitalize the patient with or without consent
91
CBT - indications
1. depression
2. generalized anx disorder
3. PTSD
4. OCD
5. Eating disorder
6. Negative thoughts pattern
92
CBT - features
combines cognitive + behavioral
challenges maladaptive cognitions
targets avoidance with behavioral techniques (relaxation, exposure, behavioral modification)
93
effective drugs during depressive phase of bipolar
- 2nd generation antipsychotics (quetiapine, lurasidone)
| - lamotrigine
94
mechanism of neuroleptic malignant syndrome
dopamine antagonism
95
parenteral nutrition - complications
1. osmotic load (so ti is for more than 48 hours through central line)
2. central-line associated bloodstream infection
3. cholelithiasias
